王靓谦 赖琳英 耿祎楠 颜彤彤 马奎 白馨月 梁黎明 陈敏亮

[摘要] 目的 比較不同功率微等离子射频治疗增生性瘢痕的效果差异。 方法 将2012年7月～2015年7月就诊于解放军总医院第一附属医院整形外科的25例增生性瘢痕患者自身瘢痕分为3个治疗区（A、B、C），分别以不同功率（70、80、90 W）微等离子射频对各区进行4次治疗，治疗间隔时间为2个月，每次治疗前均留取患者照片。于治疗前、第2次治疗后2个月（T1）、第4次治疗后6个月（T2）以温哥华瘢痕量表（VSS）评估瘢痕改善情况。 结果 所有患者均完成治疗，治疗2次后各区瘢痕外观较治疗前有所改善，肉眼观C区疗效最佳，C区VSS评分[（6.04±1.81）分]低于A区[（7.40±2.25）分]，差异有统计学意义（P < 0.05）；治疗4次后B、C区瘢痕厚度及色泽均有显著性改善，明显优于A区，B区[（4.60±1.35）分]、C区[（4.80±1.44）分]VSS评分低于A区[（5.64±1.66）分]，差异有统计学意义（P < 0.05），B区及C区评分差异无统计学意义（P > 0.05）。 结论 微等离子体射频对增生性瘢痕有剂量效应关系，在一定范围内提高治疗功率或增加治疗次数可提高治疗效率。

[关键词] 微等离子体；射频；增生性瘢痕；剂量；疗效

[中图分类号] R622 [文献标识码] A [文章编号] 1673-7210（2016）03（a）-0008-04

Evaluation of the effect of micro-plasma radiofrequency with different energy parameters in the treatment of hypertrophic scars

WANG Liangqian1 LAI Linying1 GENG Yi'nan1 YAN Tongtong1 MA Kui2 BAI Xinyue1 LIANG Liming1 CHEN Minliang1

1.Department of Burn and Plastic Surgery， the First Affiliated Hospital of General Hospital of PLA， Beijing 100048，China； 2.Key Laboratory of Wound Repair and Tissue Regeneration， General Hospital of PLA， Beijing 100048， China

[Abstract] Objective To compare the therapeutic effect of micro-plasma radiofrequency with different energy parameters in the treatment of hypertrophic scar. Methods 25 patients with hypertrophic scar treated in Burn and Plastic Surgery Department， the First Affiliated Hospital of General Hospital of PLA from July 2012 to July 2015 were enrolled. The scar of each individual patient were divided into 3 parts （A， B， C）， and each part was treated with different energy parameters setting （70， 80， 90 W） of micro-plasma radiofrequency respectively. A total of four treatment sessions were performed at 2 month intervals and clinical photographs were taken before each treatment. The improvement of scar was assessed by the Vancouver scar scale （VSS） before treatment， 2 months after the second treatment （T1） and 6 months after the fourth treatment （T2）. Results All the 25 patients completed the trial， after the second treatment， the improvement of scar can be viewed， and zone C was the best. The VSS score of zone C [（6.04±1.81） points] was lower than the zone A [（7.40±2.25） points]， with statistically significant difference （P < 0.05）. After 4 times of treatment， the thickness and color of the scars were significantly improved， and zone B， zone C were significant better than zone A. The VSS scores of zone B [（4.60±1.35） points] and zone C [（4.80±1.44） points] were lower than the zone A [（5.64±1.66） points]， with statistically significant differences （P < 0.05）； the VSS scores had no difference between zone B and zone C （P > 0.05）. Conclusion Micro-plasma radiofrequency has a significant dose-effect relationship with hypertrophic scar， and the effect is improved with the increase of energy and times of treatment.

[Key words] Micro-plasma； Radiofrequency； Hypertrophic scar； Dose； Therapeutic effect

近年来，微等离子射频（micro-plasma radiofrequency，MPR）技术在瘢痕治疗方面取得较大进展，其治疗瘢痕的效果及安全性已得到证实[1-2]。MPR的治疗效果与能量参数的设置密切相关，且因其属于微创技术，应用不当有加重原有症状的风险[3]，因而合理的能量参数设置至关重要。然而目前临床中尚无关于MPR治疗瘢痕标准能量参数的文献报道，同时也缺乏相应的随机对照研究。2012年以来，解放军总医院第一附属医院烧伤整形科（以下简称“我科”）应用MPR治疗了大量增生性瘢痕患者，取得了一定的疗效，在此基础上，本研究以不同能量MPR治疗同一例增生性瘢痕患者，通过对比疗效来探究合理的治疗能量参数，为临床治疗方案的选择提供理论依据。……