真皮及脂肪穹隆结构与烧伤后增生性瘢痕形成关系的临床研究  

Clinical study on the relationship among the dermis, fat dome and postburn hyperplastic scar formation

作　　者：李宗瑜 苏海涛 陆树良[2] 黄丽滨 杨心波 邵铁滨 李宜姝 曲滨 王成刚 张秀英 杨嵩峰 孙佳新 徐炳州 孙曼 向军[2] 

机构地区：[1]哈尔滨市第五医院烧伤科,150040 [2]上海第二医科大学瑞金医院上海市烧伤研究所

出　　处：《中华烧伤杂志》2004年第6期343-346,共4页Chinese Journal of Burns

基　　金：国家重点基础研究发展规划资助项目 (G19990 5 42 0 5)

摘　　要：目的　探讨烧伤后创面真皮组织缺损、脂肪穹隆结构破坏对增生性瘢痕形成的影响。方法　选择四肢部位需要削痂的深Ⅱ度烧伤患者 2 4例 ,共 5 4个创面。削痂术中根据创面真皮脂肪颗粒的暴露程度分为 3组 :脂肪不暴露为A组 ,脂肪暴露少为B组 ,脂肪暴露多为C组 ;再根据削痂后创面是否植皮又相应分组 :A组未植皮组、植刃厚皮组 ,B组未植皮组、植刃厚皮组 ,C组植刃厚皮组、植中厚皮组 ;每小组 9个创面。用KS4 0 0型图像分析仪测量各组患者的真皮厚度及脂肪颗粒暴露率 ;术后 6个月 ,用温哥华瘢痕评估量表评估患者瘢痕随访情况。　结果　各组患者的真皮厚度及脂肪暴露率比较 ,差异有显著性或非常显著性意义 (P <0.0 5或 0 .0 1 ) ;随着真皮缺损的增加 ,创面脂肪暴露率也相应增加 ,两者呈正相关 (γ =0.5 5 4,P <0.0 5)。A组瘢痕温哥华评分明显低于B、C组 (P<0.0 5 );B组未植皮组评分为 3.71 4± 0 .4 98,显著高于其他组 (P <0.0 1 );创面移植与缺损厚度近似的真皮 ,其瘢痕评分相应减少 ;随着脂肪暴露率增加 ,其瘢痕评分也增加 (P <0.0 5 )。　 结论　烧伤后 ,真皮组织缺损程度与增生性瘢痕的增生程度密切相关 ,而脂肪穹隆结构的破坏也是瘢痕形成过程中不容忽视的重要原因之一。Objective To explore the influence of dermal defect and fat dome structure destruction in burn wounds on the formation of hyperplastic scar . Methods Fifty two wounds in 24 burn patients with deep partial thickness burn indicating tangential excision in the extremities were enrolled in the study, and they were divided into three groups according to the extent of exposure of dermal fat granules, i e. A (without fat exposure), B (with little fat exposure) and C (with much fat exposure) groups. These three groups were subdivided into A1 (without grafting), A2 (grafting with razor thin skin), B1 (without grafting), B2 (with razor thin skin grafting), C1 (without grafting) and C2 ( with split-thickness skin grafting)groups, with 9 wounds in each group. The dermal depth and exposure rate of the fat granules in each group were measured and analyzed by KS400 photography analysis apparatus. The follow-up conditions of the scars 6 months after operation were evaluated with Vancouver remark system by Vancouver score assessment. Results There was obvious difference in the dermal depth and exposure rate of the fat granules among all the groups (P<0.05 or 0.01). The fat exposure rate was positively correlated with the extent of the dermal defect(γ=0.554,P<0.05). The Vancouver score in group A was lower than that in B and C groups(P<0.05), while that in B1 group(3.714±2.498) was evidently higher than that in other groups (P<0.01). The scar score was lowered when the wounds were grafted with the dermis with its thickness similar to the depth of the defect, The scar score was increased along with the elevation of fat exposure rate(P< 0.05). Conclusion There was a positive correlation between the degree of dermal defect and that of hyperplastic scar after burns. The disruption of fat dome structure might also be an important factor in the scar development.

关 键 词：真皮 创面 暴露 增生性瘢痕 脂肪 烧伤 患者 正相关 方法选择 破坏 

分 类 号：R644[医药卫生—外科学] R619.6[医药卫生—临床医学]