Chaiet Scott R, Marcus Benjamin C
From the Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin, Madison, WI.
Ann Plast Surg. 2016 May;76(5):477-82. doi: 10.1097/SAP.0000000000000312.
Studies of homeopathic therapies to decrease postrhinoplasty ecchymosis have previously used subjective measurements, limiting their clinical significance. Recently, Arnica montana was shown to decrease postoperative ecchymosis after rhytidectomy, using an objective measuring tool. We believe that oral A. montana, given perioperatively, can be objectively shown to reduce extent and intensity of postoperative ecchymosis in rhinoplasty surgery.
Subjects scheduled for rhinoplasty surgery with nasal bone osteotomies by a single surgeon were prospectively randomized to receive either oral perioperative A. montana (Alpine Pharmaceuticals, San Rafael, Calif) or placebo in a double-blinded fashion. Ecchymosis was measured in digital "three-quarter"-view photographs at 3 postoperative time points. Each bruise was outlined with Adobe Photoshop (Adobe Systems Incorporated, San Jose, Calif), and the extent was scaled to a standardized reference card. Cyan, magenta, yellow, black, and luminosity were analyzed in the bruised and control areas to calculate change in intensity. P value of <0.1 was set as a meaningful difference with statistical significance.
Compared with 13 subjects receiving placebo, 9 taking A. montana had 16.2%, 32.9%, and 20.4% less extent on postoperative days 2/3, 7, and 9/10, a statistically significant difference on day 7 (P = 0.097). Color change initially showed 13.1% increase in intensity with A. montana but 10.9% and 36.3% decreases on days 7 and 9/10, a statistically significant difference on day 9/10 (P = 0.074). One subject experienced mild itching and rash with the study drug that resolved during the study period.
Arnica montana seems to accelerate postoperative healing, with quicker resolution of the extent and the intensity of ecchymosis after osteotomies in rhinoplasty surgery, which may dramatically affect patient satisfaction.
以往关于顺势疗法减少隆鼻术后瘀斑的研究采用主观测量方法，限制了其临床意义。最近，使用客观测量工具显示，山金车属植物可减少除皱术后的术后瘀斑。我们认为，围手术期给予口服山金车属植物能客观地显示可减少隆鼻手术中术后瘀斑的范围和强度。
计划由单一外科医生进行鼻骨截骨隆鼻手术的受试者被前瞻性随机分为两组，以双盲方式分别接受围手术期口服山金车属植物（加利福尼亚州圣拉斐尔的阿尔派恩制药公司）或安慰剂。在术后3个时间点，通过数码“四分之三”视图照片测量瘀斑情况。每张瘀斑照片在Adobe Photoshop（加利福尼亚州圣何塞的Adobe系统公司）中勾勒轮廓，并将范围与标准化参考卡进行比对。分析瘀斑区域和对照区域的青色、品红色、黄色、黑色及亮度，以计算强度变化。将P值<0.1设定为具有统计学意义的有意义差异。
与13名接受安慰剂的受试者相比，9名服用山金车属植物的受试者在术后第2/3天、第7天和第9/10天的瘀斑范围分别减少了16.2%、32.9%和20.4%，第7天有统计学显著差异（P = 0.097）。颜色变化方面，最初服用山金车属植物时强度增加了13.1%，但在第7天和第9/10天分别下降了10.9%和36.3%，第9/10天有统计学显著差异（P = 0.074）。一名受试者在服用研究药物时出现轻度瘙痒和皮疹，在研究期间症状缓解。
山金车属植物似乎能加速术后愈合，使隆鼻手术截骨术后瘀斑的范围和强度更快消退，这可能会显著影响患者满意度。
