肥厚性瘢痕胶原酶治疗效果的初步观察

背景肥厚性瘢痕是是烧伤和创伤后局部胶原合成与降解平衡失调,胶原异常聚集的结果.目的观察胶原酶影响裸鼠移植肥厚性瘢痕胶原降解的过程,以及其对肥厚性瘢痕的治疗作用.设计对照实验.单位解放军第三军医大学西南医院康复理疗科.对象实验于1995-07/1997-04在第三军医大学实验动物中心完成.肥厚性瘢痕标本10例,均为第三军医大学西南医院整形外科手术切除的肥厚性瘢痕,术前已征得患者同意.实验动物BAVB/C裸鼠15只,雄性8只,雌性7只.共移植肥厚性瘢痕组织15只,一次存活10只,余2次移植,存活动物2只,死亡3只.将存活裸鼠随机分为胶原酶治疗组和对照组,每组6只.方法将整形手术切除的肥厚性瘢痕移植于裸鼠背部创面,建立肥厚性瘢痕裸鼠移植模型.胶原酶治疗组局部注射1%胶原酶于瘢痕组织,对照组局部注射胶原酶溶解液,1次/周,共4周,治疗结束后取材行肉眼观察、光、电镜观察和分析.主要观察指标①治疗前后瘢痕组织的肉眼观察结果.②治疗前后瘢痕组织的光镜观察结果.③治疗前后瘢痕组织的电镜观察结果.结果移植瘢痕后实验裸鼠存活12只,均进入结果分析,胶原酶治疗组6只,对照组6只.①胶原酶治疗组瘢痕面积变小、高度变低、质地变软,与对照组相差十分显著.②在苏木精-伊红染色、Van Gieson氏胶原纤维染色方法和复合染色法切片上,胶原酶治疗组真皮层变薄,胶原纤维结构模糊,排列较疏散;而对照组瘢痕组织真皮层肥厚,含丰富的胶原纤维,胶原纤维排列紊乱.③在电镜下观察,胶原酶治疗组胶原纤维被破坏,结构不清.对照组胶原纤维排列紊乱,横纹明显,结构清楚.结论胶原酶使肥厚性瘢痕胶原被降解,瘢痕变小变软,提示局部注射胶原酶可能是治疗肥厚性瘢痕较好的方法.

Primary observation of therapeutic effect of collagenase on hypertrophic scar

BACKGROUND: Hypertrophic scar results from imbalance between local collagen synthesis and degradation and abnormal aggregation of collagen after burn and trauma.OBJECTIVE: To observe the effects of collagenase on collagen degradation in nude mice with graft of hypertrophic scar and its therapeutic effects on hyertrophic scar.DESIGN: Controlled experiment was designed.SETTING: Department of Rehabilitation and Physical Therapy,Southwest Hospital, Third Military Medical University of Chinese PLA MATERIALS: The experiment was performed in Experimental Center of the Third Military Medical University of Chinese PLA from July 1995 to April 1997, in which, 10 specimens of hypertrophic scar were employed, collected from the removed hypertrophic scars in Department of Plastic Surgery.All of patients were in the known before the operation. Experimental animals were 15 BACB/C nude mice, of which, 8 mice were male and 7 mice female.Totally 15 mice were grafted with hypertrophic scar tissue, 10 mice of which were survived after once graft; with second graft in the rest mice, 2 mice were survived and 3 mice were dead. The survival nude mice were randomized into experimental group and the control, 6 mice in each one.METHODS: The removed hypertrophic scars in plastic operation were grafted in the wound on the dorsum of nude mice to establish graft model of hypertrophic scar. In experimental group, 1% collagenase was injected locally in scar tissue; in the control group, collagease solvent was injected locally, once a week, for 4 weeks totally. After treatment, the materials were collected for macrogcopic observation and observation and analysis with optic and electronic microscopes.scar tissue before and after treatment.RESULTS: Twelve nude mice were survived after scar graft and all of them entered result analysis, 6 mice of which were in experimental group was smaller in size, thinner in thickness and softer in quality compared staining, Van Gieson's collagenous fiber staining and compound staining on slices, it was displayed that in experimental group, dermal layer became thin, collagenous fiber was unclear in structure and disperse in arrangement, but in the control, the dermal layer of scar tissue was hypertrophic microscopic observation, in experimental group, collagenous fibers were destroyed and unclear in structure, but in the control, collagenous fibers were disturbed in arrangement with distinct strips and clear structure.CONCLUSION: Collagenase degrades collagen of hypertrophic scar,lessens and softens scar, suggesting that local injection of collagease is probably a good therapy for hypertrophic scar.