文献类型：期刊文献

中文题名：切口几何形态对瘢痕形成的影响及其生物力学机制研究

英文题名：Study on the effect of incision geometric morphology on scar formation and its biomechanical mechanism

作者：余小平[1];付倩倩[1];吴玉杰[2];马晓婷[2]

第一作者：余小平

机构：[1]甘肃省人民医院烧伤科,兰州730000;[2]甘肃中医药大学,兰州730000

第一机构：甘肃省人民医院烧伤科,兰州730000

年份：2025

卷号：41

期号：12

起止页码：1279

中文期刊名：中华整形外科杂志

外文期刊名：Chinese Journal of Plastic Surgery

收录：;北大核心:【北大核心2023】；

基金：兰州市科技计划项目(2022-ZD-45);甘肃省人民医院院内基金项目(21GSSYC-28);甘肃省卫生健康行业课题创新重大项目(GSWSQNPY-2025-18);甘肃省烧伤与创面修复临床医学研究中心项目(21JR7RA674)。

语种：中文

中文关键词：瘢痕;应力,物理;伤口形状;胶原重构;α-平滑肌肌动蛋白

外文关键词：Cicatrix;Stress,mechanical;Wound shape;Collagen remodeling;Smooth muscle actinα

摘要：目的比较圆形与方形切口愈合后瘢痕增生的差异,并从生物力学角度探究其潜在机制。方法采用临床回顾性分析、动物实验及有限元分析相结合的方法。在临床研究中,回顾性分析了2021年3月至2024年12月甘肃省人民医院烧伤科收治的皮肤溃疡患者临床资料。根据手术切口形态,将患者分为圆形切口组和方形切口组,术中分别将创基规划为圆形或者方形,并取中厚皮覆盖创面进行修复。术后随访12个月,计算瘢痕挛缩率,并采用温哥华瘢痕量表(VSS)评估瘢痕情况,总分0~15分,分值越高表示瘢痕越严重。在动物实验中,分别于SD大鼠背部制作相等面积的圆形和方形全层皮肤缺损创面作为圆形切口组和方形切口组。观察创面愈合情况,记录完全上皮化时间。建模后第17天,以创面中心点为圆心,取直径约1 cm的创面瘢痕组织,进行HE染色、Masson染色观察胶原纤维排列形态,检测胶原密度,并进行免疫组织化学染色检测增殖细胞核抗原(PCNA)、白细胞分化抗原31(CD31)、平滑肌肌动蛋白α(α-SMA)的阳性表达面积百分比。采用ANSYS 19.0有限元分析软件分别建立圆形、方形切口的三维力学模型,模拟皮肤组织的非线性黏弹性特征,并模拟中厚皮片移植后的创缘状态。通过施加垂直于创面的均布荷载(0.5 N),计算创缘不同部位的切向应力。符合正态分布的计量资料数据以±s表示,2组间比较采用独立样本t检验;不符合正态分布的计量资料数据以M(Q_(1),Q_(3))表示,2组间比较采用Mann-Whitney U检验。采用Pearson相关分析评估有限元分析得到的切向应力值与免疫组织化学染色检测的α-SMA阳性表达面积百分比的线性关联程度,计算Pearson相关系数r。P<0.05为差异有统计学意义。结果临床研究共纳入27例患者,年龄36~52岁,男16例,女11例。圆形切口组12例,方形切口组15例。术后12个月随访时,圆形切口组VSS评分[(2.1±0.6)分比(4.3±0.7)分,P<0.01]和瘢痕挛缩率[(22.7±2.9)%比(35.2±3.4)%,P<0.01]均明显低于方形切口组。动物实验中,圆形和方形切口组各11只雄性大鼠。方形切口组创面的完全上皮化时间明显长于圆形切口组[(21.5±2.1)d比(18.3±1.8)d,P<0.01]。建模后第17天,HE染色和Masson染色显示,圆形切口组的胶原纤维排列较规整,而方形切口组的胶原纤维排列紊乱,局部呈漩涡状,方形切口组的胶原密度高于圆形切口组[(78.4±5.2)%比(65.1±4.7)%,P<0.01];免疫组织化学染色显示,方形切口组α-SMA阳性表达面积百分比明显高于圆形切口组[(15.3±2.1)%比(8.7±1.5)%,P<0.01],而2组PCNA和CD31的阳性表达面积百分比的差异均无统计学意义(P>0.05)。生物力学有限元分析显示,方形切口角部的切向应力为(12.6±1.5)kPa,显著高于圆形切口的(3.2±0.6)kPa(P<0.01),且与α-SMA表达水平呈正相关(r=0.78,P<0.01)。结论切口几何形态是影响瘢痕预后的关键因素之一。圆形切口可通过均匀分布创缘应力形成低张力微环境,抑制肌成纤维细胞过度活化和胶原异常沉积,减轻瘢痕增生;方形切口因角部应力集中,导致持续的机械刺激,增加了形成病理性瘢痕的风险。外科手术中优化高张力区域的切口设计可能是预防病理性瘢痕的有效策略。
ObjectiveTo compare the differences in scar hyperplasia after healing of circular and square incisions,and to explore the potential mechanism from a biomechanical perspective.MethodsA combination of clinical retrospective analysis,animal experiments,and finite element analysis was adopted.In the clinical study,the clinical data of patients with skin ulcers admitted to the Department of Burns,Gansu Provincial Hospital from March 2021 to December 2024 were retrospectively analyzed.According to the surgical incision morphology,the patients were divided into the circular incision group and the square incision group.During the operation,the wound bed was designed as circular or square respectively,and split-thickness skin grafts were taken to cover the wounds for repair.The patients were followed up for 12 months after surgery to calculate the scar contracture rate,and the Vancouver scar scale(VSS)was used to evaluate scar status,with a total score ranging from 0 to 15 points(higher scores indicate more severe scars).In the animal experiment,full-thickness skin defect wounds of equal area were created on the backs of SD rats in the circular incision group and square incision group respectively.Wound healing was observed,and the time to complete epithelialization was recorded.At the 17th day after model establishment,wound scar tissue with a diameter of approximately 1 cm was obtained,with the central point of the wound as the center.HE staining and Masson staining were performed to observe the arrangement of collagen fibers and detect collagen density;immunohistochemical staining was used to determine the percentage of positive expression area of proliferating cell nuclear antigen(PCNA),cluster of differentiation 31(CD31),andα-smooth muscle actin(α-SMA).ANSYS 19.0 finite element analysis software was used to establish three-dimensional mechanical models of circular and square incisions,simulating the nonlinear viscoelastic characteristics of skin tissue and the wound edge state after split-thickness skin graft transplantation.By applying a uniform load(0.5 N)perpendicular to the wound,the tangential stress at different parts of the wound edge was calculated.Measurement data conforming to normal distribution were expressed as Mean±SD,and comparisons between the two groups were performed using independent samples t-test;data not conforming to normal distribution were expressed as M(Q_(1),Q_(3)),and Mann-Whitney U test was used for intergroup comparisons.Pearson correlation analysis was used to evaluate the degree of linear correlation between the tangential stress values obtained from finite element analysis and the percentage of positiveα-SMA expression area detected by immunohistochemical staining,and the Pearson correlation coefficient r was calculated.P<0.05 was considered statistically significant.ResultsA total of 27 patients were included in the clinical study,aged 36-52 years,including 16 males and 11 females.There were 12 patients in the circular incision group and 15 in the square incision group.At 12 months of postoperative follow-up,the VSS score[(2.1±0.6)vs.(4.3±0.7),P<0.01]and scar contracture rate[(22.7±2.9)%vs.(35.2±3.4)%,P<0.01]in the circular incision group were significantly lower than those in the square incision group.In the animal experiment,there were 11 male rats in each of the circular and square incision groups.The time to complete epithelialization of wounds in the square incision group was significantly longer than that in the circular incision group[(21.5±2.1)days vs.(18.3±1.8)days,P<0.01].At the 17th day after model establishment,HE staining and Masson staining showed that collagen fibers in the circular incision group were arranged relatively regularly,while those in the square incision group were disordered with local whorled patterns;the collagen density in the square incision group was higher than that in the circular incision group[(78.4±5.2)%vs.(65.1±4.7)%,P<0.01].Immunohistochemical staining revealed that the percentage of positiveα-SMA expression area in the square incision group was significantly higher than that in the circular incision group[(15.3±2.1)%vs.(8.7±1.5)%,P<0.01],while there were no statistically significant differences in the percentage of positive PCNA and CD31 expression areas between the two groups(P>0.05).Biomechanical finite element analysis showed that the tangential stress at the corners of the square incision was(12.6±1.5)kPa,which was significantly higher than that of the circular incision(3.2±0.6)kPa(P<0.01),and was positively correlated with theα-SMA expression level(r=0.78,P<0.01).ConclusionIncision geometric morphology is one of the key factors affecting scar prognosis.Circular incisions can uniformly distribute wound edge stress to form a low-tension microenvironment,inhibiting excessive activation of myofibroblasts and abnormal collagen deposition,thereby reducing scar hyperplasia.In contrast,square incisions lead to continuous mechanical stimulation due to stress concentration at the corners,increasing the risk of pathological scar formation.Optimizing incision design in high-tension areas during surgery may be an effective strategy for preventing pathological scars.