部分切除甲板\甲基质联合甲沟重建治疗重度嵌甲症疗效观察(1)
[摘要] 目的：探讨部分切除甲板、甲基质联合甲沟重建治疗重度嵌甲症的疗效。方法：将门诊292例重度嵌甲症患者根据患者及家属意愿分成观察组210例和对照组82例。观察组采用部分切除甲板、甲基质联合甲沟重建治疗，对照组采用传统的拔甲术治疗，比较两组患者近期疗效和远期疗效。结果：观察组近期疗效愈合202例，延迟愈合8例；对照组愈合60例，延迟愈合22例，两组经χ2检验，差异有统计学意义(χ2=33.90，P<0.01)；两年后观察组6例复发，对照组49例复发，两组经χ2检验，差异有统计学意义(χ2=124.89，P<0.01)。结论：部分切除甲板、甲基质联合甲沟重建治疗重度嵌甲症复发率低，疗效好。
[关键词] 重度嵌甲症；外科手术；甲沟重建
[中图分类号] R758.72[文献标识码]B [文章编号]1673-7210(2011)07(b)-240-02
Observation of partial excision of nail plate，onychostroma combined with reconstruction of nail groove for the treatment of severe ingrowing nail
, 百拇医药
LIYun1, LI Wei1, Pu Jianyi2
1.The Hospital of Kailuan Group Company, Tangshan 063000, China;2.The Affiliated Hospital of Hebei Combination University, Tangshan 063000, China
[Abstract] Objective: To observe partial excision of nail plate, onychostroma combined with reconstruction of nail groove for the treatment of severe ingrowing nail. Methods: 292 patients of clinic service were assigned two groups according to the will of paients or their family member.Obseration groups used partial excision of nail plate, onychostroma combined with reconstruction of nail groove, control groups used routone cutting nail, Then Compare in the near future therapeutic effect and prostecdtive efficacy of two groups. Results: Obseration groups has 210 paitents, 202 patients healing in the near future, 8 paitents late healed; 60 paitens healing in control groups, 22 patients late healed. The groups use chi-square criterion, the outcome was significantly than that of control groups(χ2=33.90, P<0.01). 6 patients palindromia after two years later in the obseration groups, 49 patients palindromia in control groups, the outcome was also significantly than that of control groups(χ2=124.89, P<0.01). Conclusion: The partial excision of nail plate, onychostroma combined with reconstruction of nail groove for the treatment of severe in growing nail is a reasonable simple manipulation with, less traumatic, therapeutic effect well, lower recurrent rate.
, 百拇医药
[Key words] Severe Ingrown nail; Surgical procedures operative; Reconstruction of nail groove
嵌甲症是外科门诊常见病，重度嵌甲症多由于迁延或反复发作的嵌甲及甲沟炎，伴发化脓或形成增生性肉芽肿[1]，引起趾甲沟部疼痛，患者行走受限，严重影响工作和生活，笔者所在医院2000年1月～2010年2月采用患侧甲板、甲基质部分切除联合甲沟重建治疗210例足拇趾重度嵌甲症，与传统拔甲术比较，取得满意疗效现介绍如下：
1 资料与方法
1.1 一般资料
根据患者及家属意愿分成观察组和对照组，观察组采用患侧甲板、甲基质部分切除联合甲沟重建共有210例，对照组采用拔甲术治疗重症嵌甲症者为82例。观察组年龄18～65岁，平均29.2岁；单侧右足拇趾122例，单侧左足拇趾82例，双足拇趾6例；单足外侧甲沟炎115例，单足内侧甲沟炎87例，单足双侧甲沟炎6例，双足双侧甲沟炎2例。对照组年龄20～61岁，平均28.4岁，单侧右足拇趾45例，单侧左足拇趾34例，双足拇趾3例；单侧外侧甲沟炎46例，单侧内侧甲沟炎30例，单足双侧甲沟炎4例，双足双侧甲沟炎2例。
, http://www.100md.com
1.2 治疗方法
①观察组：术前给予口服抗生素、引流脓液或鱼石脂软膏外敷等处理，待无脓性分泌物，炎症减轻后进行手术治疗。趾根部神经阻滞麻醉后上橡皮止血带，在嵌甲一侧梭形切除宽约0.2 cm甲沟处的肉芽组织至趾骨。沿甲沟切开掀起甲根部皮肤1.0 cm，纵行切除患侧约1/5的甲板、甲基质至趾骨，生理盐水冲洗伤口，甲沟的皮肤边缘不与甲床、趾甲缝合，开放甲沟。只缝合切开的甲根部皮肤。切除后的甲沟间隙宽0.2～0.3 cm，如甲沟过宽，可在甲沟靠近趾尖部与趾甲缝l针，甲沟用凡士林纱条填塞，包扎伤口，放止血带。术后l周内服用抗生素，换药至伤口愈合，术后2周伤口拆线。②对照组：术前处理和观察组一样，用刀片做甲上皮下、甲板下分离，持针器钳住甲板一侧缘向甲板背侧旋转，拔下甲板，用凡士林纱布压迫包扎甲基质，术后处理同观察组，10 d后待甲基质干燥后以少量敷料包扎待新甲长出。
1.3 疗效判定
分为近期疗效和远期疗效，近期疗效判断根据愈合与延迟愈合，愈合判断标准为伤口愈合，甲沟无红、肿、热、痛、分泌物，无肉芽肿。延迟愈合判断标准为伤口继发轻度感染，愈合时间大于2周。远期疗效判断根据两组患者于治愈后2年进行电话随访观察其复发率，复发判断标准为治愈1年后再次出现嵌甲症的症状体征。, http://www.100md.com(李 允 李 伟 浦践一)
[关键词] 重度嵌甲症；外科手术；甲沟重建
[中图分类号] R758.72[文献标识码]B [文章编号]1673-7210(2011)07(b)-240-02
Observation of partial excision of nail plate，onychostroma combined with reconstruction of nail groove for the treatment of severe ingrowing nail
, 百拇医药
LIYun1, LI Wei1, Pu Jianyi2
1.The Hospital of Kailuan Group Company, Tangshan 063000, China;2.The Affiliated Hospital of Hebei Combination University, Tangshan 063000, China
[Abstract] Objective: To observe partial excision of nail plate, onychostroma combined with reconstruction of nail groove for the treatment of severe ingrowing nail. Methods: 292 patients of clinic service were assigned two groups according to the will of paients or their family member.Obseration groups used partial excision of nail plate, onychostroma combined with reconstruction of nail groove, control groups used routone cutting nail, Then Compare in the near future therapeutic effect and prostecdtive efficacy of two groups. Results: Obseration groups has 210 paitents, 202 patients healing in the near future, 8 paitents late healed; 60 paitens healing in control groups, 22 patients late healed. The groups use chi-square criterion, the outcome was significantly than that of control groups(χ2=33.90, P<0.01). 6 patients palindromia after two years later in the obseration groups, 49 patients palindromia in control groups, the outcome was also significantly than that of control groups(χ2=124.89, P<0.01). Conclusion: The partial excision of nail plate, onychostroma combined with reconstruction of nail groove for the treatment of severe in growing nail is a reasonable simple manipulation with, less traumatic, therapeutic effect well, lower recurrent rate.
, 百拇医药
[Key words] Severe Ingrown nail; Surgical procedures operative; Reconstruction of nail groove
嵌甲症是外科门诊常见病，重度嵌甲症多由于迁延或反复发作的嵌甲及甲沟炎，伴发化脓或形成增生性肉芽肿[1]，引起趾甲沟部疼痛，患者行走受限，严重影响工作和生活，笔者所在医院2000年1月～2010年2月采用患侧甲板、甲基质部分切除联合甲沟重建治疗210例足拇趾重度嵌甲症，与传统拔甲术比较，取得满意疗效现介绍如下：
1 资料与方法
1.1 一般资料
根据患者及家属意愿分成观察组和对照组，观察组采用患侧甲板、甲基质部分切除联合甲沟重建共有210例，对照组采用拔甲术治疗重症嵌甲症者为82例。观察组年龄18～65岁，平均29.2岁；单侧右足拇趾122例，单侧左足拇趾82例，双足拇趾6例；单足外侧甲沟炎115例，单足内侧甲沟炎87例，单足双侧甲沟炎6例，双足双侧甲沟炎2例。对照组年龄20～61岁，平均28.4岁，单侧右足拇趾45例，单侧左足拇趾34例，双足拇趾3例；单侧外侧甲沟炎46例，单侧内侧甲沟炎30例，单足双侧甲沟炎4例，双足双侧甲沟炎2例。
, http://www.100md.com
1.2 治疗方法
①观察组：术前给予口服抗生素、引流脓液或鱼石脂软膏外敷等处理，待无脓性分泌物，炎症减轻后进行手术治疗。趾根部神经阻滞麻醉后上橡皮止血带，在嵌甲一侧梭形切除宽约0.2 cm甲沟处的肉芽组织至趾骨。沿甲沟切开掀起甲根部皮肤1.0 cm，纵行切除患侧约1/5的甲板、甲基质至趾骨，生理盐水冲洗伤口，甲沟的皮肤边缘不与甲床、趾甲缝合，开放甲沟。只缝合切开的甲根部皮肤。切除后的甲沟间隙宽0.2～0.3 cm，如甲沟过宽，可在甲沟靠近趾尖部与趾甲缝l针，甲沟用凡士林纱条填塞，包扎伤口，放止血带。术后l周内服用抗生素，换药至伤口愈合，术后2周伤口拆线。②对照组：术前处理和观察组一样，用刀片做甲上皮下、甲板下分离，持针器钳住甲板一侧缘向甲板背侧旋转，拔下甲板，用凡士林纱布压迫包扎甲基质，术后处理同观察组，10 d后待甲基质干燥后以少量敷料包扎待新甲长出。
1.3 疗效判定
分为近期疗效和远期疗效，近期疗效判断根据愈合与延迟愈合，愈合判断标准为伤口愈合，甲沟无红、肿、热、痛、分泌物，无肉芽肿。延迟愈合判断标准为伤口继发轻度感染，愈合时间大于2周。远期疗效判断根据两组患者于治愈后2年进行电话随访观察其复发率，复发判断标准为治愈1年后再次出现嵌甲症的症状体征。, http://www.100md.com(李 允 李 伟 浦践一)