不同时期瘢痕挛缩状态的临床治疗方式探索  

Exploration of clinical treatment modalities for different periods of scar contracture

作　　者：葛小静 苏新 王立夫 李楚鋆 周芳 姚刚 GE Xiaojing;SU Xin;WANG Lifu;LI Chujun;ZHOU Fang;YAO Gang(Department of Plastic and Burn Surgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210019,China)

机构地区：[1]江苏省人民医院(南京医科大学第一附属医院)整形烧伤外科,江苏南京210029

出　　处：《中国美容整形外科杂志》2023年第11期647-652,共6页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨不同时期瘢痕挛缩状态的治疗方式选择及临床治疗效果。方法回顾性分析自2019年3月至2021年3月,江苏省人民医院(南京医科大学第一附属医院)整形烧伤外科收治的55例瘢痕患者。一组为早期瘢痕患者(早期组,1~6个月)共34例,采用超脉冲CO_(2)点阵激光治疗,间隔3个月行第2次治疗,分别于首次治疗前和末次治疗后3个月,按照温哥华瘢痕量表(vancouver scar scale,VSS)评分评估瘢痕情况,关节处按照关节最大活动角度测量方法,对比治疗前后情况。记录治疗过程中的不良反应情况。另一组为稳定期挛缩瘢痕(稳定期组,6个月至48年),共21例,伴有关节功能障碍患者15例,采用瘢痕组织瓣(皮下蒂菱形皮瓣、Z成形术及衍生瓣等)松解挛缩瘢痕,设计的松解切口均在瘢痕组织内,部分缺损联合少量0.35 mm的断层皮片移植修复。术前及术后6个月测量关节最大活动度,比较关节功能改善情况;记录皮瓣/皮片成活情况,手术并发症等。结果早期组末次治疗后3个月,瘢痕的色泽、厚度、血管分布、柔软度以及VSS总评分均较治疗前明显降低(t=4.95、5.78、6.40、5.92、15.37,P均<0.05)。涉及关节区域者在随访时均无功能障碍,关节活动度(range of motion,ROM)较治疗前明显变大(t=-5.07,-4.97,-4.29,-4.68,P均<0.05),分别有28例(82.4%)显效,5例(14.7%)有效,1例(2.9%)无效,总有效率为97.06%(33/34),所有患者无增厚、感染。稳定期组治疗后,所有关节功能均得到有效改善,差异有统计学意义(P<0.05)。17例(81.0%)显效,4例(19.0%)有效,无无效患者,总有效率为100%(21/21)。1例皮片少许感染溶解,1例皮瓣尖端淤紫,均在换药处理后愈合。结论瘢痕的挛缩治疗应在早期干预,改善瘢痕质地的同时,治疗或预防了关节功能障碍,CO2点阵激光对早期瘢痕挛缩状态的治疗是有效的。手术采用瘢痕组织瓣设计治疗稳定期的挛缩瘢痕,既能有效改善挛缩状Objective To explore the treatment modalities for different periods of scar contracture and the summary of clinical treatment results.Methods From March 2019 to March 2021,A retrospective study of 55 patients admitted to the Department of Jiangsu Provincial People's Hospital(The First Affiliated Hospital of Nanjing Medical University).A group of 34 cases with early scarring(early group,within 1-6 months after injury)were treated with ultra-pulsed CO2 fractional laser,with a second treatment at an interval of 3 months.Scarring was assessed according to the Vancouver Scar Scale(VSS)score before the first treatment and 3 months after the last treatment.Comparison of the maximum range of motion(ROM)before and after treatment.Record the adverse reactions during the treatment.The other group was stable contracture scar with joint dysfunction.A total of 21 patients(stable period group,with scar formation time of 6 months to 48 years)were treated with scar tissue flaps(including subcutaneous pedicle rhomboid flap,Z-plasty flap and their combination model)and minor defects in combination with little scattered skin grafts.The designed release incisions are all within the scar tissue,and some defects are repaired with a small amount of 0.35 mm fault skin graft.Maximal active ROM was measured preoperatively and 6 months postoperatively to compare the improvement of joint function;flap/skin piece survival and surgical complications were recorded.Results In the early group,3 months after the last treatment,the color,thickness,vascular distribution,pliability,and total VSS score were significantly lower than in the pre-treatment period(t=4.95,5.78,6.40,5.92,15.37,P<0.05).None of the joints were dysfunctional,and ROM became significantly greater than before treatment(t=-5.07,-4.97,-4.29,-4.68,P<0.05).Both 28 cases(82.4%)showed significant efficacy,5 cases(14.7%)were effective,and 1 case(2.9%)was ineffective.The total effective rate was 97.06%(33/34),and all cases showed no thick ening or infection.All joint functions were effect

关 键 词：挛缩 瘢痕 激光 松解 瘢痕组织瓣 

分 类 号：R622[医药卫生—整形外科]