| Keloid is a common disease and an innocuousness skin tumor, which originates from hyperplasy of connectivum after skin injury. The patients sometimes have cicatrices body constitution, the coloured race is easier to fall ill and female is more commonly seen than male,having obvious family history. At present, its pathogenesy is still unknown ,may be have some connection with growth factor,apoptosis,extracellular matrix,and so on.There are mainly these methods to treat keloid clinically , such as surgery,laser therapy,cryotherapy,radiation therapy,drug therapy and pressure treatment technique etc, there exist good quality also shortcoming to each method above. At present, radionuclide application method is in most common use clinically.It is many years since 90Sr was applied to treat keloid, this method has several fortis, such as fewer curing number,quickly,safe,cheaper and no pain etc , and it has been more and more emphasized clinically. Using radionuclide 90Sr application to treat keloid, we put the specially made 90Sr application on the affection part, 90Sr decaying to emitβray , affecting the scar tissue , the effectorganizes in cicatrices, degeneration , necrosis happened in the collagenoblast among them cell after ionization radiation effect , combining and deposition cutting down a collagen to achieve treat purpose. 90Srsβray penetration ability in tissue is weak, penetration depth is shallow, the ultimate range in corpore is 11 mm , the ray energy permeating 2 mm tissue is not more than 26 % ,when permeating 6 mm there is only 1% left. It does no harm to deep tissue, and is apt to cure the keloid. Previously, 90Sr application applied to cure keloid are mainly many times low dose irradiation method and one time high-dose irradiation method. the therapeutic efficacy is relatively bad , needing repeated therapy, causing part patients hard to insist and give up treatment. Founding one kind of effective method to cure the keloid is the question paid close attention to and discussed by the nuclear medicine workers.In the text , we used allotted high-dose 90Sr application to cure 146 cases of keloid patients , male patients 56 examples , female patients 90 examples , the age from 5 months to 73 years , mean age is 33 years , and the course from 2 months to 20 years. All patients are the keloid outpatients that were diagnosed at nuclear medicine section in the second hospital of Jilin University from March of 2005to august of 2006, apt to applied by 90Sr treat。Expose dose every time is 2000 ~ 3000 cGy, 7-15 days one time, 3 to 4 times one course. Take 100 cases of keloid patients who had been cured by conventional low dose 90Sr application by fractionation within March of 2004 and February of 2005 as comparison , male patients 38 cases , female patients 62 cases , age from 2 to 72 years , and mean age is 38 years , course from 3 months to 18 years. Exposure dose each time is 300-350 cGy, one time a day, continuous 7days is a treatment course. If the patient among two groups had not been cured in one course, he or she can get repeated treatment after 2 months .We take regular follow-up to all cases above, the shortest time is 6 months , the longest is 15 months.Curative effect assessment standard (1)healing : keloid disappear , no longer erupt , itching disappear.(2) excellence : keloid flatten obviously, but still higher than the skin , texture softening , itching disappear. (3) effective : keloid deflate slightly , or not obviously , but texture softening , itching softening of disappear . (4)invalid : the size and texture of keloid not change , itching doesn't disappear , or continue to grow post-therapy.In 246 patients , male 90 cases , female 156 cases , the ratio of male to female is 1:1.6,most common is teenagers(44.7%),the predilection site by turns is thoracic part,back,upper limb,abdomen,waist.It is found after four course therapy in high dose 90Sr application by fraction therapy group and conventional low dose 90Sr application by fraction therapy group : 1,Among 146 cases of keloid patients cured by high dose 90Sr application by fraction , the healing rate post one course is 54.1%,the accumulating healing rate post two courses is 74.0%,and 87.7% keloid can be cured after three courses , the accumulating healing rate post four courses is up to 95.9%; but among the 100 cases of keloid patients cured by conventional low dose 90Sr application by fraction , there is no healing case after one course , the accumulating healing rate post two courses is 10%,the accumulating healing rate is 40% post three courses, and the accumulating healing rate is 62% post four courses。It illustrates the healing rate of the high dose by fraction therapy group is obviously higher than that of the conventional low dose by fraction therapy group , and there exists significance between two groups(P <0.01).2,The side effect incidence postone course cured by conventional low dose by fraction is 4%,and the accumulating incidence is 10% after four courses , and both are light side effect , no heavy side effect. The side effect incidence post one course cured by high dose by fraction is 19.8% , the accumulating rate post four courses is 56.1%,obviously higher than conventional low dose group , and there exists significance between the light side effect incidences and the heavy side effect incidence of the third and fourth course in both two groups (P <0.01) , though the accumulating side effect incidence in the first and second course cured by large dose by fraction in higher than the conventional low dose by fraction group , there doesn't exist significance between two groups (P >0.05)。And the majority of the side effect in high dose by fraction group is light effect ,the heavy side effect post one course is only 2.7%,the accumulating rate post four courses is 8.2%。It illustrates that the side effect and its degree of high dose by fraction group is obviously higher than that of conventional low dose group by fraction。The effect of keloid cured by 90Sr application is concerned with the area and thickness of the keloid , the smaller and thinner the keloid and the shorter of the course , the better of the effect , and themajority have been cured ; the bigger and thicker of the keloid and the longer of the course , the worse of the effect , needing several courses to heal。Therefore , once finding the keloid , the therapy should be carried as soon as possible。Moreover , the individual sensitiveness degree to ray,the partial exposure time (dose) to keloid and the interval between two treating course have a direct impact to the therapeutic efficacy of 90Sr application , it is considered in this study that the best interval between two course is 2 months。The side effect of 90 Sr application arised almost from 0.5 to 1 month post therapy , mainly appears as swelling,erythema,pigmentation,spalling and water blister etc , which can disappear without special handling automaticly ; the heavy side effect can arise in few patients such as the surface of keloid appears destroyed to ulcer。To destroyed or ulcer , spreading vitamin B12 and Gentamicin can speed up the healing and prevent the infection。The part decolorization post the healing of raw surface。The worse of the side effect , the flattener of the keloid post the healing of the raw surface , so there is direct ration between curative effect and the degree of side effect。There is no system side effect and partial skinirreversible damage in the study cured by high dose 90Sr application method, which illustrates the high dose of 90Sr application in the study is safe。In short , the effect of high-dose 90Sr application by fraction is obviously higher than conventional low dose by fraction group , it shortened the curing time of keloid, though the side effect incidence is high , only limited to partial keloid , will heal after a period of time , not seeing the skin irreversible damage cases , technology reasonable , having high clinical application value , can be extended to clinical use.
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