Methods From January to December 2018, 59 patients with hyperplastic scars after burns admitted to Kunshan Rehabilitation Hospital were divided into rehabilitation group (n=30) and laser group (n=29) by the random number table method. Conventional scar treatments in the rehabilitation group and laser group include: topical silicone preparations, pressure therapy, scar massage, ultrasound therapy, etc.; both the rehabilitation group and laser group were received burn rehabilitation treatment [exercise therapy (joint mobility training, joint loosening therapy, muscle strength training, aerobic training, etc.), occupational therapy (daily self-care ability training, hand function training, recreational activities, etc.), physical factor therapy (air pressure therapy, red and blue light therapy on wounds, etc.), psychological rehabilitation, orthopedic therapy, hydrotherapy, etc.]. Patients in the laser group were treated with carbon dioxide fractional laser treatment on the basis of conventional scar treatment and burn rehabilitation treatment, once every 2 months. Both groups of patients were treated continuously for 12 months. Before and after treatment (at the 12th month after enrollment), the Vancouver scar scale (VSS) was used to assess the scar; before treatment, immediately after the first laser treatment, 1 d after the first laser treatment, 14 d after the first laser treatment, and after treatment (at the 12th month after enrollment), the degree of scar tightening of patients were scored by the visual analogue scale (VAS); after treatment (at the 12th month after enrollment), the VAS was used to evaluate the patient′s satisfaction with the scar curative effect and the satisfaction rate was calculated; the occurrence of adverse reactions in patients within 12 months were recorded. The data were analyzed by t test, Mann-Whitney U test, Wilcoxon test and chi-square test.
Results (1) Before treatment, there was no significant difference in VSS score between the two groups (Z=-0.777, P>0.05); after treatment (at the 12th month after enrollment), the VSS scores of patients in the laser group and rehabilitation group were [10.00 (9.00, 10.00) points and 12.00 (10.75, 13.00) points], which were significantly lower than those before treatment, the differences were statistically significant (Z=-4.795, -4.852; with P values below 0.05), and the VSS score of the laser group was significantly lower than that of the rehabilitation group, the difference was no statistically significant (Z=-4.514, P<0.05). (2) Before treatment, there was no significant difference in the VAS score of the degree of scar tightening between the two groups (Z=-1.420, P>0.05); immediately after the first laser treatment, 1 d after the first laser treatment, 14 d after the first laser treatment, and after treatment (at the 12th month after enrollment), the VAS score of the degree of scar tightening in the laser group [2(1, 3), 3( 3, 4), 6 (6, 7), 7 (6, 7) points] were significantly lower than before treatment [10(10, 10) points], and the differences were statistically significant (Z=-4.736, -4.788, -4.760, -4.767; with P values below 0.05); patients in the rehabilitation group immediately after the first laser treatment, 1 d after the first laser treatment, 14 d after the first laser treatment, and after treatment (at the 12th month after enrollment), the VAS score of the degree of scar tightness [8 (8, 10), 9 (9, 10), 8 (8, 9), 8 (8, 9) points] were significantly lower than the before treatment [10 (9, 10) points], the differences were statistically significant (Z=-5.035, -2.828, -2.449, -5.002; with P values below 0.05); and immediately after the first laser treatment, 1 d after the first laser treatment, 14 d after the first laser treatment, and after treatment (at the 12th month after enrollment), the VAS scores of the patients in the laser group were significantly lower than those in the rehabilitation group, the differences were statisctically significant (Z=-6.651, -6.732, -4.953, - 6.029, with P values below 0.05). (3) After treatment (at the 12th month after enrollment), the frequency distribution of satisfaction grading in the laser group was statistically different than that in the rehabilitation group (Z=-2.214, P=0.027); the satisfaction rate of patients in the laser group (58.62%) was high than that in the control group (36.67%); the difference in the number of satisfied cases/dissatisfied cases in the laser group (17/12) and the rehabilitation group (11/19) was statistically significant (χ2=9.696, P=0.002). (4) The incidence of adverse reactions in the laser group was 10.34% (3/29), and the incidence of adverse reactions in the rehabilitation group was 6.67% (2/30), there was no statistically significant difference in the incidence of adverse reactions between the two groups (χ2 =0.579, P=0.447).