微创瘢痕松解联合自体小颗粒脂肪移植在面部凹陷性瘢痕中的应用  

Application of minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar

作　　者：赵倩楠 周粤闽 刘振楠 孙朝阳 张舒曼 刘若璇 Zhao Qiannan;Zhou Yuemin;Liu Zhennan;Sun Chaoyang;Zhang Shuman;Liu Ruoxuan(Department of Plastic and Reconstructive Surgery,Huaihe Hospital,Henan University,Kaifeng 475000,China)

机构地区：[1]河南大学淮河医院整形修复外科,开封475000

出　　处：《中华整形外科杂志》2021年第4期371-375,共5页Chinese Journal of Plastic Surgery

基　　金：河南省科技发展计划项目(172102410005);河南大学研究生"英才计划"(SYL18060140);河南省医学科技攻关计划项目(201401014)。

摘　　要：目的探讨微创瘢痕松解联合自体小颗粒脂肪移植治疗面部凹陷性瘢痕的临床效果。方法2015年9月至2019年5月,河南大学淮河医院收治面部凹陷性瘢痕患者11例,男5例,女6例,年龄5~27岁,中位年龄20岁。均以针状瘢痕分离器或10 ml注射器针头,经皮潜行剥离瘢痕组织、充分松解瘢痕纤维化粘连;从腹部抽取自体脂肪颗粒,静置、分离纯化后用1 ml注射器将脂肪均匀注入剥离后间隙及其周围0.5 cm范围。采用温哥华瘢痕量表、石溪瘢痕量表对治疗前、治疗后3及6个月瘢痕进行评分,采用视觉模拟量表进行患者满意度评价。数据分析采用SPSS 25.0,计量资料如果符合正态性及方差齐性,以±s表示,对多时点数据应用单因素重复测量方差分析,组内两两比较采用Bonferroni法分析。P<0.05为差异有统计学意义。结果11例患者治疗后即刻瘢痕凹陷消失,6个月后观察可见瘢痕表面平坦,颜色和弹性接近正常皮肤,局部皮肤质地柔软。随访6个月所有患者无复发,11例患者满意。治疗前、治疗后3及6个月温哥华瘢痕量表评分分别为(7.27±1.10)分、(2.64±0.81)分和(0.91±0.54)分,三者比较差异有统计学意义(F=467.98,P<0.001);治疗后3及6个月分别与治疗前比较,差异均有统计学意义(P<0.001),治疗后3个月与6个月比较,差异有统计学意义(P<0.001)。治疗前、治疗后3、6个月石溪瘢痕量表评分分别为(2.00±0.89)分、(3.91±0.70)分和(4.45±0.69)分,三者比较差异有统计学意义(F=67.00,P<0.001);治疗后3、6个月分别与治疗前比较,差异均有统计学意义(P<0.001),治疗后3个月与6个月比较,差异有统计学意义(P=0.006)。治疗后6个月视觉模拟量表患者满意度评价为(95.00±6.74)分。11例中有1例出现术后结节,经曲安奈德注射和按摩后缓解。结论微创瘢痕松解联合自体小颗粒脂肪移植治疗凹陷性瘢痕,可避免新的瘢痕形成及再次粘连,有效改善瘢痕的�Objective To investigate the clinical effect of minimally invasive scar release combined with autologous microfat graft in the treatment of facial depressed scar.Methods From September 2015 to May 2019,a total of 11 patients who had facial depressed scar were treated with minimally invasive scar release combined with autologous microfat graft in Huaihe Hospital of Henan University.Needle scar separator or 10 ml syringe needle was inserted under skin to release scar adhesion thoroughly.Microfat was harvested from the abdomen,which was separated and purified,and then evenly transplanted into the stripped space(0.5 cm wider than the edge of scar)under the scar with a 1 ml syringe.The severity of scar was evaluated pre-operation,3-month post-operation and 6-month post-operation,using Vancouver Scar Scale score and Stony Brook Scar Evaluation Scale score to evaluate the efficacy.Using Visual Analogue Scale score to evaluate patient satisfaction.Analyses were performed using SPSS Statistics 25.0,and measurement data were expressed as Mean±SD if they conformed to normality and homogeneity of variance.One-way ANOVA was used for multi-time point data,and the Bonferroni test was performed for pairwise comparison.P<0.05 was considered a statistically significant difference.Results The depression of scars disappeared immediately after treatment.6 months after treatment,the surface of the scars was flat,the color and elasticity were close to adjacent normal skin,and the texture of the scars was soft.All patients were followed up for 6 months without recurrence,and 11 patients were satisfied.In Vancouver Scar Scale score,the pre-operation score was 7.27±1.10,the 3-month post-operation score was 2.64±0.81 and the 6-month post-operation score was 0.91±0.54,showing a significant difference(F=467.98,P<0.001).Pairwise comparison result show that comparing the pre-operation score with 3 or 6 months post-operation score,showing a significant difference(P<0.001).The comparison between 3 and 6 months post-operation score also showi

关 键 词：瘢痕 腹部脂肪 移植 自体 最小侵入性外科手术 瘢痕松解 

分 类 号：R622[医药卫生—整形外科]