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嵌甲的病因學探討及療效分析

探討嵌甲的病因，分析手術治療嵌甲的有效性。 方法 2000 年4 月－ 2005 年4 月，收治82例中、重度嵌甲患者。其中男48 例，女34 例；年齡14 ～ 25 歲，平均19.5 歲。均為口止母 趾發病，其中甲緣單側44 例，雙側38 例。就診前復發次數：初診12 例，1 次復發者20 例，2 次復發者26 例，3 次及以上復發者24 例。術前口止母 趾外露甲體寬度患側為（16.51 ± 0.27）mm，健側為（16.56 ± 0.26）mm。手術將糜爛增生的甲皺襞、嵌入的趾甲及其下的甲床、嵌甲的甲根一并切除。 結果 82 例患者術后傷口愈合時間10 ～ 18 d，平均12.3 d。2 例傷口感染，經換藥后愈合。68 例獲隨訪3 個月～ 3 年6 個月，平均1 年4 個月，無1 例復發。術后隨訪功能評價，9 分以上62 例，占91.2%。從82 例患者中隨機抽選20 例進行數據分析，術后口止母 趾外露甲體寬度患側為（16.46 ± 0.27）mm，健側為（16.56 ± 0.26）mm，與術前比較差異均無統計學意義（P gt; 0.05），外形滿意。 結論 嵌甲的發生與不良修甲有關，正確選擇術式不僅能根治嵌甲，而且可獲得美觀外形。

足母趾部分甲皺襞和甲床楔形切除治療嵌甲

CLINICAL STUDY ON TREATMENT OF OBSTINATE INGROWN NAIL WITH DISTAL PHALANX OF GREAT TOE AND SOFT TISSUE ORTHOPAEDICS

Objective To investigate the clinical curative effect of distal phalanx of great toe and soft tissue orthopaedics for treatment of obstinateingrown nail. Methods From October 1997 to May 2006,31 patients(38 nails) suffering from obstinate ingrown nail were treated by the distal phalanx of great toe and soft tissue orthopaedics. There were 23 males(27 nails) and 8 females(11 nails) with an average age of 17.5 years(12-28 years). The disease course was 2years and 1 month to 14 years(average, 31-6 months). At the same time, thirty-eight patients with diseases of feet were selected randomly as controls. The depth of the nail groove was measured.The X-ray films were taken to calculate the rate of upward projection of tuberosity (r). Results Thedepth of the nail and r value of 31 patients were 2.87±0.31 mm and 0.149±0.013，respectively. There were statistically significant differences when compared with control group（1.06±0.10 mm and 0.060±0.019）（Plt;0.01）. Thirty patients(37 nails) had a primary healing; 1 patient(1 nail) had a delayed healing. Twenty-nine patients(36 nails) were followed up for 8 to 29 months(average, 21 months). The appearance of the nail was satisfactory. No relapse occurred in all patients. Conclusion The upward projection of tuberosity of distal phalanx of great toe and deepened nail groove are the most important anatomical causes for ingrown nail. The distal phalanx of great toe and soft tissue orthopaedics is aneffective treatment for obstinate ingrown nail.

MODIFIED SURGICAL REPAIR OF SEVERE INGROWN TOENAIL

Objective To summarize the effectiveness of modified surgical repair for severe ingrown toenail. Methods Between January 2005 and December 2010, 13 patients with severe ingrown toenail (16 toes) were treated. There were 12 males (15 toes) and 1 female (1 toe), aged 18-32 years with an average of 20 years. The disease duration was 1-15 years (mean, 2 years and 9 months). All affected toes were great toes. Ingrown toenail occurred bilaterally in 3 cases and unilaterally in 10 cases. Granulation tissue surrounding nail-edge, embedded toenail, and necrotic nail bed were completely removed; tension glue was used to make wound edge close to nail bed. Results At 3-5 days after operation, wound congestion, swelling, and exudation were improved; at 7 days, new nail bed formed; at 2 weeks, all wounds healed, and nail bed was epitheliogenic, wound edge healed well close to nail plate, and patients returned to normal life. At 6 months after nail extraction, new toenail grew and nail groove formed. No recurrent sign was found during 24-month follow-up. Conclusion Modified surgical repair is one of effective methods to treat severe ingrown toenail with the advantages of good appearance and low recurrent rate.