切口增生性瘢痕与正常皮肤的弹性和血管差异:一项基于客观评价的对比研究

Differences in elasticity and vascularity between incisional hypertrophic scar and normal skin:a comparative study using objective evaluations

目的 探索综合采用剪切波弹性成像技术(shear wave elastography,SWE)以及光学相干断层扫描血管成像技术(optical coherence tomography angiography,OCTA)测量并比较切口增生性瘢痕(incisional hypertrophic scar, IHS)与正常皮肤的生物力学和血管微结构的差异。方法 自2022年9月至2023年12月,解放军总医院第一医学中心整形修复科门诊收集25例甲状腺及剖宫产手术术后线性IHS的患者,收集患者基本资料信息,采用主观量表:温哥华瘢痕评估量表(vancouver scar scale,VSS)及患者/观察者评估量表(patient and observer scar assessment scale,POSAS)评估瘢痕基本情况,并采用客观评估手段:SWE和OCTA综合定量评价IHS及其周围皮肤的厚度、硬度、血管密度、血管管径、血管复杂度等指标,比较瘢痕及其周围皮肤的差异。结果 与正常皮肤相比,IHS的厚度[(0.212±0.074)cm:(0.116±0.025)cm,P<0.001]及硬度[(42.032±23.825)kPa:(10.879±3.436)kPa,P<0.001]均显著升高。微血管情况方面,IHS血管密度相较于正常皮肤更大[(0.394±0.073):(0.339±0.090),P<0.05],血管平均管径及最大管径均有显著提高[(109.303±19.187)μm:(88.288±12.425)μm,P<0.001;(524.118±120.964)μm:(438.805±70.193)μm,P<0.05],但在血管复杂度方面,其与正常皮肤比较差异无统计学意义[(0.405±0.087):(0.451±0.090),P=0.06]。结论 SWE和OCTA能够客观、定量地评价IHS及其周围正常皮肤。IHS比周围正常皮肤更厚,质地更硬,血管管径更粗,血管密度更大,二者复杂程度无显著差异。

Objective To explore the use of shear wave elastography(SWE)and optical coherence tomography angiography(OCTA)to measure and compare the differences in biomechanics and vascular microstructure between incisional hypertrophic scar and normal skin.Methods From September 2022 to December 2023,twenty-five patients with incisional hypertrophic scar after cesarean section and thy-roidectomy were collected from the Department of Plastic and Reconstructive Surgery,the First Medical Center of PLA General Hospital.The basic information of the patients was collected.The vancouver scar scale(VSS)and the patient and observer scar assessment scale(POSAS)were used to evaluate the basic situation of the scar,and the objective assessment methods,including SWE and OCTA,were used to quantify the thickness,stiffness,vascular density,vascular diameter,and vascular complexity of scar and its surrounding skin,so as to estimate the differences between scar and its surrounding skin.Results Compared with normal skin,the thickness[(0.212±0.074)cm:(0.116±0.025)cm,P<0.001] and stiffness[(42.032±23.825)kPa:(10.879±3.436)kPa,P<0.001]of incisional hypertrophic scar were significantly increased.For the micro-vascular situation,the vascular density of scar was larger than that of normal skin[(0.394±0.073):(0.339±0.090),P<0.05],and the average and maximum diameter of vessels were significantly increased[(109.303±19.187)μm:(88.288±12.425)μm,P<0.001;(524.118±120.964)μm:(438.805±70.193)μm,P<0.05],but there was no significant difference in vascular com-plexity between scar and normal skin[(0.405±0.087):(0.451±0.090),P=0.06].Conclusion SWE and OCTA can objectively and quan-titatively evaluate the incisional hypertrophic scar and its surrounding normal skin.Compared with the normal skin around the incision,the incisional hypertrophic scar is thicker and harder,and the blood vessel diameter is thicker and the blood vessel density is larger.There is no significant difference in the complexity between the both of them.