机械磨削术与CO₂点阵激光治疗凹陷性痤疮瘢痕的自身对照研究

Self-Controlled Study of Mechanical Dermabrasion and CO₂ Fractional Laser in the Treatment of Acne with Depressed Scars

摘要: 目的：比较机械磨削术与CO₂点阵激光治疗凹陷性痤疮瘢痕的疗效及不良反应。方法：选取笔者医院2024年9月~2025年6月收治的10例凹陷性痤疮瘢痕患者面部左右近似对称分布的瘢痕为研究对象，取得48组面部近似对称分布的凹陷性痤疮瘢痕，总计96例瘢痕。按随机分配法将每组两个瘢痕分为A组和B组，A组予以机械磨削术治疗，B组予以CO₂点阵激光治疗。统计第一次治疗后30 d两组的治疗有效率、瘢痕面积与恢复面积、患者与观察者瘢痕评估量表(POSAS)得分、创口结痂以及脱痂所需的时间、不良反应发生率、患者满意度。采用SPSS25.0统计软件分析数据，计量资料组间比较采用独立样本t检验或配对t检验；计数资料组间比较采用卡方检验。结果：第一次治疗后30 d，A组治疗有效率及患者满意度均高于B组(P < 0.05)；A、B两组瘢痕面积均较治疗前明显降低(P < 0.05)，且A组瘢痕恢复面积(0.93 ± 0.83) mm²高于B组(0.25 ± 0.39) mm²，组间差异具有统计学意义(P < 0.05)；A、B两组POSAS得分均较治疗前明显降低(P < 0.05)；A组结痂与脱痂时间大于B组(P < 0.05)；两组的不良反应主要表现为瘙痒、色素沉着、疼痛，其中A组色素沉着率高于B组(P < 0.05)，两组的瘙痒、疼痛发生率差异均无统计学意义(P > 0.05)。结论：与CO₂点阵激光相比，机械磨削术治疗凹陷性痤疮瘢痕的临床效果显著，可以提高治疗有效率与瘢痕恢复面积，患者满意度更高，但伴随着色素沉着率增高的风险。

Abstract: Objective: This study aims to compare the efficacy and adverse reactions of mechanical dermabrasion and CO₂ Fractional Laser in the treatment of acne with depressed scars. Method: The study subjects comprised 48 pairs of facial acne scars with near-symmetrical distribution on the left and right sides of the face, obtained from 10 patients with atrophic acne scars admitted to our hospital between September 2024 and June 2025. A total of 96 scars were collected. The two scars in each group were randomly assigned to either Group A or Group B. Group A received mechanical dermabrasion, while Group B received CO₂ fractional laser therapy. This study statistically evaluates the following parameters at 30 days post-initial treatment for both groups: treatment efficacy rate, scar area and recovery area, the Patient and Observer Scar Assessment Scale (POSAS) scores, wound scab formation and time required for scab detachment, postoperative adverse reactions, and patient satisfaction. SPSS 25.0 statistical software was adopted for data analysis in this study. For comparison of measurement data between groups, the independent-samples t-test or paired t-test was used; for comparison of enumeration data between groups, the chi-square test was applied. Results: Thirty days after the first treatment, both the treatment efficacy rate and patient satisfaction in Group A were higher than those in Group B (P < 0.05); Scar area decreased significantly in both Groups A and B compared to pre-treatment levels (P < 0.05). The scar recovery area in Group A (0.93 ± 0.83) mm² was higher than that in Group B (0.25 ± 0.39) mm², with a statistically significant intergroup difference (P < 0.05). Both Groups A and B showed significantly reduced POSAS scores compared to pre-treatment levels (P < 0.05); Group A exhibited longer scab formation and desquamation times than Group B (P < 0.05). Adverse reactions in both groups primarily included pruritus, hyperpigmentation, and pain. The incidence of hyperpigmentation was higher in Group A than in Group B (P < 0.05), while the incidence rates of pruritus and pain showed no statistically significant difference between the two groups (P > 0.05). Conclusion: Compared to CO₂ fractional laser therapy, mechanical dermabrasion demonstrates significantly superior clinical efficacy in treating atrophic acne scars. It enhances treatment success rates and scar recovery areas while achieving higher patient satisfaction. However, it carries an increased risk of hyperpigmentation.