点阵二氧化碳激光治疗挛缩性瘢痕的临床疗效  

Clinical effect of fractional carbon dioxide laser in the treatment of contracture scars

作　　者：喜雯婧 张铮[1] 李洁[1] 苏薇洁[1] 李华[1] 濮哲铭[1] 张艳[1] 冯少清[1] 章一新[1] Xi Wenjing;Zhang Zheng;Li Jie;Su Weijie;Li Hua;Pu Zheming;Zhang Yan;Feng Shaoqing;Zhang Yixin(Department of Plastic and Reconstructive Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,200011

出　　处：《中华烧伤杂志》2021年第8期711-717,共7页Chinese Journal of Burns

基　　金：基金项目国家自然科学基金面上项目(81772098);国家自然科学基金青年科学基金项目(81801918,82000456,82002064,81801917);上海市领军人才计划;申康发展中心三年行动计划(SHDC2020CR2045B);上海市科学技术委员会优秀技术带头人计划(18XD1423700);上海市卫生和计划生育委员会科研课题(20154Y0023);上海市教委高峰高原计划—“研究型医师”项目(20152227);黄浦区产业扶持基金(XK2020008);上海交通大学医工(理)交叉基金(YG2019QNB09);上海交通大学医学院附属第九人民医院临床研究型多学科诊疗团队建设项目(2017-1-007);上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ027);上海交通大学医学院附属第九人民医院“交叉”研究基金(JYJC202009)。

摘　　要：目的探讨点阵二氧化碳激光治疗挛缩性瘢痕的临床疗效。方法采用回顾性自身前后对照研究方法。2016年12月—2021年4月,上海交通大学医学院附属第九人民医院收治16例伴有造成关节功能障碍的挛缩性瘢痕患者,其中男7例、女9例,年龄3~49岁。对18处关节瘢痕进行点阵二氧化碳激光治疗,每2~3个月1次,直至受累关节恢复正常活动范围或者疗效达到瓶颈。记录每例患者治疗次数;首次治疗前和末次治疗后6个月,测量每例患者受累关节活动度并计算差值,采用温哥华瘢痕量表(VSS)评估每例患者瘢痕情况;于6例患者各1处关节瘢痕的1次治疗(共6次治疗)中,记录当次治疗前、治疗后即刻及治疗后第1次随访时受累关节活动度并计算治疗后2个时间点与治疗前的差值;记录治疗区域治疗后不良反应发生情况;末次随访时,采用自制问卷调查患者治疗间隙和随访期间功能锻炼执行情况和其他瘢痕治疗手段使用情况。对数据进行Wilcoxon秩和检验。结果本组16例患者18处关节瘢痕接受了2(1,3)次点阵二氧化碳激光治疗;末次治疗后6个月受累关节活动度为56.5(39.0,128.8)°,明显高于首次治疗前的38.4(22.9,116.3)°(Z=-3.724,P<0.01),改善了17.4(8.0,24.1)°;末次治疗后6个月瘢痕VSS评分中的血管分布、柔软度、厚度评分及总分均明显低于首次治疗前(Z=-2.989、-3.762、-2.814、-3.739,P<0.01),其中柔软度改善最为明显。在6次治疗中,当次治疗后即刻、治疗后(2.5±0.6)个月第1次随访时受累关节活动度分别为156.2(148.0,164.2)°、160.2(156.7,166.4)°,均较治疗前的151.4(145.7,155.3)°明显增加(Z=-2.201、-2.201,P<0.05),分别改善了9.1(4.4,13.0)°、13.1(8.0,15.7)°。本组患者治疗区域治疗后均未观察到水疱、感染、增生性瘢痕形成等不良反应。多数患者在治疗间隙和随访期间进行过功能锻炼,使用过压力衣/套、硅酮药物和支具。结论点阵二�Objective To explore the clinical effect of the fractional carbon dioxide laser in the treatment of contracture scars.Methods A retrospective before-after self-control study was conducted.From December 2016 to April 2021,16 patients(7 males and 9 females,aged 3-49 years)with contracture scars causing impaired function of the adjacent joint were admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.Eighteen joint scars of 16 patients were treated with fractional carbon dioxide laser every 2-3 months until the joint retained its normal range of motion or the effect plateaued.The treatment times of each patient were recorded.Before the first treatment and 6 months after the last treatment,the ranges of motion of the affected joint were measured in each patient,and the difference was calculated,meanwhile,the Vancouver Scar Scale(VSS)was used to evaluate the scar of each patient.In the treatment of 1 joint scar in each of 6 patients(totally 6 times of treatments),the ranges of motion of the affected joint before the current treatment,immediately after the treatment,and at the first follow-up after the treatment were documented,and the differences between the ranges before and immediately after the treatment as well as between the ranges before and at the first follow-up after the treatment were calculated.Adverse effects after the treatment in the treatment area were documented.At the last follow-up,a self-made questionnaire was used to collect the implementation status of the physical therapy and other scar management modalities during the treatment interval and follow-up period.Data were statistically analyzed with Wilcoxon rank sum test.Results Eighteen joint scars in 16 patients received 2(1,3)times of fractional carbon dioxide laser treatment.The range of motion of the affected joint of 16 patients 6 months after the last treatment was 56.5(39.0,128.8)°,notably higher than 38.4(22.9,116.3)°before the first treatment(Z=-3.724,P<0.01),showing a remarkable impr

关 键 词：瘢痕 激光疗法 疗效比较研究 

分 类 号：R364.1+6[医药卫生—病理学] R605[医药卫生—基础医学]