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皮肤扩张器治疗瘢痕的临床应用效果观察

[Observation on the clinical application effects of skin distractor on the treatment of scars].

作者信息

Gui W L, Yang E, Zhang H S

机构信息

Department of Plastic and Burn Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2017 Mar 20;33(3):139-144. doi: 10.3760/cma.j.issn.1009-2587.2017.03.003.

Abstract

To explore clinical application effects of skin distractor on the treatment of scars and to observe effects of skin distractor with different pull speeds on different parts scars of human body. One hundred and four patients with scars, conforming to the study criteria, were hospitalized in our unit from January 2014 to June 2015. Patients were divided into 2 mm/d group and 4 mm/d group according to the random number table, with 52 patients in each group. After admission, skin distractors were pasted on scars in face and neck, trunk, and extremities of patients in 2 groups, with inner edges of pasteboards close to outside edges of longer sides of scars. Skin distractors in 2 mm/d group and 4 mm/d group were pulled to scars axis direction as speeds of 2 mm/d and 4 mm/d, respectively. Pull time equals values of pull speeds divided by width of scars. Scars were resected after finishing pulling. Immediately after scars resection, skin distractors were pasted again with inner edges of pasteboards close to outside edges of longer sides of incision and removed when stitches were taken out. Scars of patients were scored by Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) was used to record scores of patient scar assessment scale (PSAS), observer scar assessment scale (OSAS) and overall scores of patients and observers of scars of patients before and one year after scars resection. Data were processed with (2) test, independent samples test, paired samples test, independent samples non-parametric rank-sum test and paired samples non-parametric rank-sum test. (1) Scores of all scars of patients in 2 groups before scars resection were close (with values from -1.384 to 0.622, values above 0.05), obviously higher than those of one year post scars resection (with values from 11.085 to 24.835, values below 0.01). Scores of scars in face and neck, trunk and extremities in 2 groups before scars resection were close (with values from -1.651 to -0.035, values from -1.549 to 0.219, values above 0.05), significantly higher than those of one year post scar resection (with values from -2.992 to -2.555, values from 8.739 to 19.076, values below 0.01). (2) Scores of all scars of patients in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with values from -2.583 to -2.018, values below 0.05). PSAS scores of scars in face and neck and trunk in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with values respectively -2.385 and -2.198, values below 0.05), other scores of scars in face and neck and trunk of patients in 2 groups of one year post scars resection were close (with values from -1.841 to -0.363, values above 0.05). VSS scores, PSAS scores, OSAS scores, patients' overall scores, and observers' overall scores in 2 mm/d groups were (4.6±0.8), (28±4), (28±4), (4.7±0.7), (4.8±1.4) points, respectively, lower than those in 4 mm/d group[(5.2±0.8), (32±4), (31±6), (5.5±1.2), (5.5±1.0) points, respectively, with values from -3.712 to -2.105, <0.05 or <0.01]. Skin distractor has better effects on the treatment of scars, and treatment effects of skin distractor in extremities pulled by 2 mm/d are better than those pulled by 4 mm/d.

摘要

探讨皮肤牵张器治疗瘢痕的临床应用效果,观察不同牵拉速度的皮肤牵张器对人体不同部位瘢痕的影响。2014年1月至2015年6月,我科收治符合研究标准的瘢痕患者104例。根据随机数字表将患者分为2 mm/d组和4 mm/d组,每组52例。两组患者入院后,将皮肤牵张器粘贴于面部、颈部、躯干及四肢瘢痕处,粘贴板内缘靠近瘢痕较长边的外缘。2 mm/d组和4 mm/d组皮肤牵张器分别以2 mm/d和4 mm/d的速度向瘢痕轴心方向牵拉。牵拉时间等于牵拉速度值除以瘢痕宽度。牵拉结束后切除瘢痕。瘢痕切除后立即再次粘贴皮肤牵张器,粘贴板内缘靠近切口较长边的外缘,拆线时去除。采用温哥华瘢痕量表(VSS)对患者瘢痕进行评分,采用患者和观察者瘢痕评估量表(POSAS)记录患者瘢痕评估量表(PSAS)、观察者瘢痕评估量表(OSAS)评分及患者和观察者对患者瘢痕切除前及切除后1年瘢痕的总体评分。数据采用χ²检验、独立样本t检验、配对样本t检验、独立样本非参数秩和检验和配对样本非参数秩和检验进行处理。(1)两组患者瘢痕切除前所有瘢痕评分相近(χ²值为-1.384至0.622,P值均>0.05),明显高于瘢痕切除后1年(χ²值为11.085至24.835,P值均<0.01)。两组患者面部、颈部、躯干及四肢瘢痕切除前评分相近(χ²值为-1.651至-0.035,χ²值为-1.549至0.219,P值均>0.05),明显高于瘢痕切除后1年(χ²值为-2.992至-2.555,χ²值为8.739至19.076,P值均<0.01)。(2)瘢痕切除后1年,2 mm/d组患者所有瘢痕评分低于4 mm/d组(χ²值为-2.583至-2.018,P值<0.05)。瘢痕切除后1年,2 mm/d组患者面部、颈部及躯干瘢痕的PSAS评分低于4 mm/d组(χ²值分别为-2.385和-2.198,P值<0.05),两组患者面部、颈部及躯干瘢痕切除后1年的其他评分相近(χ²值为-1.841至-0.363,P值>0.05)。2 mm/d组VSS评分、PSAS评分、OSAS评分、患者总体评分及观察者总体评分分别为(4.6±0.8)、(28±4)、(28±4)、(4.7±0.7)、(4.8±1.4)分,低于于4 mm/d组[分别为(5.2±0.8)、(32±4)、(31±6)、(5.5±1.2)、(5.5±1.0)分,χ²值为-3.712至-2.105,P<0.05或P<0.01]。皮肤牵张器治疗瘢痕效果较好,2 mm/d牵拉四肢瘢痕的治疗效果优于4 mm/d。

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