急诊断层甲片翻转修复甲床部分缺损疗效观察

EMERGENCY TREATMENT OF NAIL BED PARTIAL DEFECT WITH SPLIT NAIL

目的探讨急诊采用断层甲片翻转修复甲床部分缺损的疗效。方法 2008年2月-2011年8月,收治27例30指甲床部分缺损患者。男19例22指,女8例8指;年龄16～64岁,平均27.4岁。损伤原因:机器冲压伤25例,切割伤2例。损伤指别:拇指3指,示指7指,中指11指,环指9指。受伤至入院时间30 min～7 h,平均4.3 h。甲床缺损范围4 mm×3 mm～9 mm×5 mm。急诊清创后,切取4 mm×3 mm～10 mm×6 mm残留甲床的断层甲片,翻转修复甲床缺损。结果术后25例28指断层甲片顺利成活,甲床创面Ⅰ期愈合;2例2指出现创面渗出,经积极换药后断层甲片成活,创面愈合。23例25指获随访,随访时间5～17个月,平均11.1个月。指甲于术后3～5个月全部再生;除2例延期愈合者指甲生长欠佳外,其余患者指甲面光滑、平整,指尖捏持功能正常,叩击无疼痛。末次随访时,根据指甲再生疗效评价标准评定,获优15指,良6指,可3指,差1指,优良率84%。结论急诊采用残留甲床的断层甲片翻转修复甲床部分缺损手术操作简便,并能获得较好疗效。

Objective To investigate the effectiveness of split nail in the emergency treatment of nail bed partial defect.Methods Between February 2008 and August 2011,27 cases（30 fingers） of nail bed partial defect were treated.There were 19 males（22 fingers） and 8 females（8 fingers） with an average age of 27.4 years（range,16-64 years）.The causes of injury included machine injury in 25 cases and cutting injury in 2 cases.The injured fingers included 5 thumbs,7 index fingers,11 middle fingers,and 9 ring fingers.The disease duration ranged from 30 minutes to 7 hours with an average of 4.3 hours.The size of nail bed defect ranged from 4 mm × 3 mm to 9 mm × 5 mm.All defects were repaired with residual split nail（4 mm？× 3 mm-10 mm？× 6 mm in size）.Results The split nail survived in 25 cases（28 fingers）,and primary healing of wound was obtained.Exudation occurred in 2 cases（2 fingers） and was cured after symptomatic treatment.Twenty-three patients（25 fingers） were followed up 5-17 months（mean,11.1 months）.At 3-5 months after operation,the fingernail regeneration was observed in all fingers.Except 2 cases（2 fingers） of delayed healing having poor nail growth,the other patients had smooth nail and normal finger tip function without pain.According effectiveness standard for fingernail regeneration,the results were excellent in 15 fingers,good in 6 fingers,fair in 3 fingers,and poor in 1 finger,with an excellent and good rate of 84%.Conclusion It is a simple and effective method to use residual split nail for emergency treatment of nail bed partial defect.