评价局部注射复方倍他米松注射液联合类人胶原蛋白瘢痕修复硅凝胶治疗增生性瘢痕的疗效。

将2018年12月至2020年10月沈阳积水潭医院收治的70例增生性瘢痕患者按随机数字表法分为实验组和对照组，每组35例。实验组采取局部注射复方倍他米松注射液＋外涂类人胶原蛋白瘢痕修复凝胶治疗，将复方倍他米松注射液(≤40 mg)注入患者瘢痕组织内，直至瘢痕呈膨隆状态、瘢痕表皮微白，每4周注射1次；每次注射后第2天开始，取适量类人胶原蛋白瘢痕修复凝胶(1～2 mg)均匀涂抹于瘢痕表面，2次/d，待瘢痕组织缩小、变平后，停用复方倍他米松，仅外用类人胶原蛋白瘢痕修复凝胶，注射3～4次为1个疗程。对照组仅采用复方倍他米松注射液治疗，方法及剂量同实验组。每4周注射1次，待瘢痕组织缩小、变平后停止治疗，注射3～4次为1个疗程。观察2组患者治疗期间不良反应发生情况，瘢痕变平及颜色接近正常皮肤时间，治疗后16周对患者临床疗效进行判定，门诊随访半年，记录患者瘢痕复发情况。数据比较采用t检验和χ²检验。

治疗过程中，实验组患者中出现皮肤萎缩1例、毛囊炎1例，不良反应发生率为5.7%；对照组患者中出现皮肤萎缩1例，毛囊炎2例，不良反应发生率为8.6%，2组比较差异无统计学意义(χ²＝ 0.001, P>0.05)。实验组瘢痕变平时间为(4.50±2.80)周，瘢痕颜色接近正常皮肤的时间为(7.5±2.7)周，对照组瘢痕变平时间为(6.23±2.80)周，瘢痕颜色接近正常皮肤的时间为(14.5±4.7)周，2组比较差异均有统计学意义(t＝8.312、12.532, P<0.05)。治疗后16周，实验组显效28例，有效5例，无效2例，治疗的总有效率为94.3%；对照组显效30例，有效4例，无效1例，治疗的总有效率为97.1%，2组比较差异无统计学意义(χ²＝ 0.001, P>0.05)。随访半年，实验组瘢痕复发率为3.0% (1/33)，对照组为11.8%(4/34)，2组比较差异有统计学意义(χ²＝3.858，P<0.05)。

局部注射复方倍他米松注射液联合类人胶原蛋白瘢痕修复硅凝胶治疗增生性瘢痕具有复发率低、瘢痕变平时间及颜色恢复时间明显缩短的优点，值得推广。

To evaluate the efficacy of the combined application of local injection of compound Betamethasone and human-like collagen scar repair gel in the treatment of hypertrophic scar.

Seventy patients with hypertrophic scar were admitted to Shenyang Jishuitan Hospital from December 2018 to October 2020 were divided into experimental group and control group according to the random number table method, 35 patients in each group. The experimental group were treated with the local injection of compound Betamethasone combined with human-like collagen scar repair gel. Compound Betamethasone(≤40 mg) was injected into the scar until the scar was bulging and slightly white, once every four weeks. From the second day after each injection, the human-like collagen scar repair gel(1-2 mg) was applied on the surface of the scar, twice a day. After the scar was reduced and flattened, the injection was stopped and the human-like collagen scar repair gel was only appied. One course of treatment needed 3 to 4 injections. In the control group, patients were treated simply with the local injection of compound Betamethasone and the method and dose were the same as the experimental group. Inject once every 4 weeks and stop the treatment after the scar was flatten. One course of treatment needed 3 to 4 injections. The occurrence of adverse reactions during the treatment of the two groups of patients was observed; the time when the scars became flat and the color was close to normal skin were observed; the clinical efficacy of the patients was judged 16 weeks after treatment and the patients were followed up for six months to record the recurrence of scars. Data were compared with t test and chi-square test.

During the treatment, there was 1 case of skin atrophy and 1 case of folliculitis in the experimental group, and the incidence of adverse reactions was 57%. In the control group, there was 1 case of skin atrophy and 2 cases of folliculitis, with an adverse reaction rate of 8.6%, and there was no statistically significant difference between the two groups(χ²=0.001, P>0.05). The time of scar flattening in the experimental group was (4.50±2.80) weeks, and the time of scar color approaching normal skin was (7.5±2.7) weeks, the time of scar flattening in the control group was (6.23±2.80) weeks, and the time of scar color approaching normal skin was (14.5±4.7) weeks, there were statistically significant differences between the two groups (t=8.312, 12.532; P<0.05). After 16 weeks of treatment in the experimental group, 28 cases were significantly affected, 5 cases were effective, and 2 cases were ineffective, the total effective rate of treatment was 94.3%; in control group 30 cases were significantly affected, 4 cases were effective, and 1 cases were ineffective, the total effective rate of treatment was 94.3%. There was no significant difference between the two groups (χ²=0.001, P>0.05). After half a year of follow-up, the scar recurrence rate was 3.0% (1/33) in the experimental group and 11.8% (4/34) in the control group. The difference between the two groups was statistically significant (χ²=3.858, P<0.05).

Local injection of compound Betamethasone injection combined with human-like collagen scar repair gel for the treatment of hypertrophic scars has the advantages of low recurrence rate, shorter scars flattening time and shorter color recovery time, which is worthy of promotion.