| Objective To study the efficacy and safety of combined application of hyaluronidase and triamcinolone acetonide in the treatment of keloid,searching a safe and effective method for the treatment of keloid.Methods 96 Keloid patients which were remedied in Cosmetology Departmentfrom of Weifang Yidu Central Hospital during in September 2011 to March 2014 had been selected as the research objects.They were randomly divided into two groups,including 48 cases of treatment group with combined injection of hyaluronidase and triamcinolone acetonide;48 cases of control group with treatment by injection of triamcinolone acetonide only.The keloid was divided into mild,moderate and severe by Vancouver Scale according to four indexes: color,thickness,vascular distribution and softness.Treatment methods were carried out as described as follows: The treatment group was administrated with the combination of Triamcinolone Acetonide 1ml(40mg),2% lidocaine and hyaluronidase mixture(2.5ml),2% lidocaine(0.5ml);The control group was treated with Triamcinolone Acetonide 1ml(40mg).All the liquid was injected into the scar tissue from the scar margin to the point of puncture inward evenly and slowly with the high pressure syringe,until local tissue became pale.The treatment was repeated one or two weeks every time,four or eight weeks for a period and all treatments sustained for one or two courses.For 3,6 and 12 months after treatments,all patients were asked to contrast the clinical symptoms of two groups before and after treatment such as scar color,scar thickness and scar flexibility.At the same time,the cure rate,effective rate and incidence of complications of the two methods were evaluated according to the criteria of curative effect.Results ?Comparison of two groups of patients before treatment: there was no significant difference between the two groups in age,sex ratio,scar area,duration of disease,location of the lesion and scar(P>0.05).(2)Comparison of clinical efficacy between the two groups: in all of the treatment group of 46 patients,28 cases were cured,markedly effective in 16 cases,ineffective in 2 cases;otherwise,in all of the control group of 43 patients,18 cases were cured,markedly effective in 21 cases,ineffective in 4 cases.The rank sum test showed that the clinical efficacy of the treatment group was significantly better than that of the control group(P<0.01).(3)The cure rate and effective rate of the two groups were compared: the cure rate of the treatment group was 60.9%(28/46),the effective rate was 95.7%(44/46);the cure rate of the control group was 41.9%(18/43),the effective rate was 90.7%(39/43);The cure rate and effective rate of the treatment group were significantly higher than those of the control group.(4)Comparison of the Vancouver scale score between the two groups before and after treatment: the treatment group and the control group before treatment Vancouver scale score was 8.63±1.67 and 8.28± 1.35 respectively,no significant statistical difference was shown(p>0.05).Two groups after treatment of patients with the Vancouver scale score was 4.89 ±1.14 and 6.35 ±1.08,which was significantly lower than before treatment(p<0.01),However,the treatment group decreased more significantly,and Vancouver score was significantly lower than the control group(p<0.05).(5)The clinical symptoms of the two groups were compared: there was no significant difference between the treatment and the control group before and after treatment(p>0.05).After treatment,pain and pruritus scores were significantly decreased compared with before treatment(p<0.01).However,the treatment group decreased more significantly,the treatment group after treatment of pain scores and pruritus scores were significantly lower than those in the control group(p<0.05).(6)the side effects and recurrence of the two groups were compared: There were 2 female patients in each group with early menstruation and increased menstrual volume,and they recovery without any treatment,after two months.In control group,one patient had local skin blackening,but no ulceration,gradually recovered after one month.In the treatment group,one case was ineffective,and another case had a relapse,and in the control group,one case was ineffective,and three cases showed a recurrence Conclusion(1)Hyaluronidase lesions combined with triamcinolone acetonide injection in the treatment of keloid has good curative effect,which is better than intralesional with triamcinolone acetonide only.It is safe and reliable,and is worthy of clinical application;(2)Combined injection of hyaluronidase and triamcinolone acetonide in lesions of keloid can be facilitated in primary hospitals with no large equipment,due to simplicity and,low treatment costs and reliable effect. |
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