Observation on the clinical application effects of skin distractor on the treatment of scars
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摘要: 目的 探讨皮肤牵张器在瘢痕治疗中的临床应用效果,并观察其不同牵拉速度在不同部位瘢痕中的治疗效果。 方法 2014年1月—2015年6月,笔者单位收治符合入选标准的104例瘢痕患者,按随机数字表法分为2 mm/d组和4 mm/d组,每组52例。入院后针对2组患者面颈部、躯干及四肢瘢痕,粘贴皮肤牵张器,使粘贴板内缘紧贴于瘢痕长轴方向外缘,2 mm/d组和4 mm/d组分别以2 mm/d、4 mm/d的速度向瘢痕中轴线牵拉皮肤。牵拉时间为瘢痕宽度除以速度。牵拉结束后行瘢痕切除术,术后即刻再次粘贴皮肤牵张器,使粘贴板内缘紧贴于切口长轴方向外缘,拆线时拆除。术前和术后1年,运用温哥华瘢痕量表(VSS)对患者瘢痕进行评分,运用患者和观察者瘢痕评价量表(POSAS)对患者瘢痕进行患者瘢痕评价量表(PSAS)评分、观察者瘢痕评价量表(OSAS)评分、患者总体评分及观察者总体评分。对数据行
χ 2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及配对样本非参数秩和检验。 结果 (1)2组患者术前瘢痕总体各项评分相近(t 值为-1.384~0.622,P 值均大于0.05),均显著高于术后1年(t 值为11.085~24.835,P 值均小于0.01)。2组患者术前面颈部、躯干及四肢瘢痕各项评分相近(Z 值为-1.651~-0.035,t 值为-1.549~0.219,P 值均大于0.05),均显著高于术后1年(Z 值为-2.992~-2.555,t 值为8.739~19.076,P 值均小于0.01)。(2)2 mm/d组患者术后1年瘢痕总体各项评分均低于4 mm/d组(t 值为-2.583~-2.018,P 值均小于0.05)。2 mm/d组患者术后1年面颈部及躯干瘢痕PSAS评分低于4 mm/d组(Z 值分别为-2.385、-2.198,P 值均小于0.05),2组患者术后1年面颈部及躯干瘢痕其余各项评分相近(Z 值为-1.841~-0.363,P 值均大于0.05)。2 mm/d组患者术后1年四肢瘢痕VSS评分、PSAS评分、OSAS评分、患者总体评分、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,均低于4 mm/d组的(5.2±0.8)、(32±4)、(31±6)、(5.5±1.2)、(5.5±1.0)分(t 值为-3.712~-2.105,P <0.05或P <0.01)。 结论 皮肤牵张器的瘢痕治疗效果良好,以2 mm/d的速度牵拉治疗四肢瘢痕效果较4 mm/d更佳。-
关键词:
- 瘢痕 /
- 四肢 /
- 皮肤牵张器 /
- 温哥华瘢痕量表 /
- 患者和观察者瘢痕评价量表
Abstract: Objective 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. Methods 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 withχ 2 test, independent samplest test, paired samplest test, independent samples non-parametric rank-sum test and paired samples non-parametric rank-sum test. Results (1) Scores of all scars of patients in 2 groups before scars resection were close (witht values from -1.384 to 0.622,P values above 0.05), obviously higher than those of one year post scars resection (witht values from 11.085 to 24.835,P values below 0.01). Scores of scars in face and neck, trunk and extremities in 2 groups before scars resection were close (withZ values from -1.651 to -0.035,t values from -1.549 to 0.219,P values above 0.05), significantly higher than those of one year post scar resection (withZ values from -2.992 to -2.555,t values from 8.739 to 19.076,P 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 (witht values from -2.583 to -2.018,P 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 (withZ values respectively -2.385 and -2.198,P 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 (withZ values from -1.841 to -0.363,P 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, witht values from -3.712 to -2.105,P <0.05 orP <0.01]. Conclusions 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.
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