趾端骨软组织矫形术在顽固性嵌甲中的应用

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

目的探讨趾端骨、软组织矫形术治疗顽固性嵌甲的临床效果。方法1997年10月-2006年5月，收治顽固性晦趾嵌甲患者31例38趾，采用白行设计的趾端骨、软组织矫形术治疗。男23例27趾，女8例11趾。年龄12～28岁，平均17．5岁。病程2年1个月～14年，平均31．6个月。均经5～9次拔甲治疗。合并甲沟炎急性期14例18趾，甲沟炎慢性期17例20趾。选取同期收治足部疾病但晦趾完整38例患者作对照。测量患者甲沟深度及摄X线片，测量爪粗隆上翘比例r值。结果患者甲沟深度及r值分别为2．87±0．31mm及0．149±0、013，与对照组1、06±0.10mm及0．060±k0．019比较，差异均有统计学意义（P〈0．01）。术后30例37趾伤口I期愈合，1例1趾伤口延迟愈合。29例36趾获随访8～29个月，平均21个月。趾端外形良好，无复发或再次手术。结论（足母）趾末节趾骨爪粗隆上翘、甲沟肥大变深是（足母）嵌甲重要的解剖学病因，采用趾端骨软组织矫形术是根治顽固性嵌甲的一种有效手术方法。

Objective To investigate the clinical curative effect of distal phalanx of great toe and soft tissue orthopaedics for treatment of obstinate ingrown 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 {emales（11 nails） with an average age of 17.5 years（12-28 years）. The disease course was 2 years 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 The depth 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） （P〈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 an effective treatment for obstinate ingrown nail.