甲床修补结合甲板原位缝合治疗儿童甲床损伤

Cliniacal Study of Bed Nail Repair Combined with Fingernail Normal Position Suture for Treatment of Children Subungal Hematomas

目的回顾性分析儿童甲下血肿合并甲床裂伤的相关致伤因素以及行甲床修补结合甲板原位缝合术治疗儿童甲下血肿的的预后。方法对2010年2月一2012年3月期间在笔者医院急诊手术室接受甲床修补＋甲板原位缝合术的43个儿童病例进行回顾性分析。其中男性患儿28例，女性患儿15例，年龄1-13岁，平均年龄5．7岁。优势侧手致伤率约为48％（17／35），有8名（19％）患者由于年幼无法明确优势手。右手受伤25例（58％），左手18例（42％）。中指致伤率51％（22例），小指27．8％（12例），环指11．6％（5例），示指6．9％（3例），拇指2．7％（1例）。43名患者均由钝性伤所致，其中房门夹伤21例（48．8％），车门夹伤13例（30．2％），石块压伤9例（21％）。甲下血肿面积占25％-50％28例（65．1％），50％-75％8例（18．6％），〉75％7例（16．3％）。58％的甲床裂伤位于手指远节近端1／3，余位于手指远节远端2／3，其中单纯纵、横裂伤28例（65．1％），放射状裂伤15例（34．9％），16指合并远节指骨粉碎性骨折，但无一例出现骨折移位或骨折波及关节面。结果所有患者在术后均得到了随访，平均随访时间为7．3个月。术后随访过程中有5例发生并发症，2例患指新生指甲出现横向凹陷，3指出现新生甲体粗糙、肥厚，但手指功能未受影响。余患者或家长均对手指外形及功能满意。结论采用甲床修补结合甲板原位缝合治疗儿童甲下血肿合并甲床裂伤，方法简单、安全，疗效确切，手指外形和功能恢复满意。

Objective To retrospectively analysis the related injury factors of children under the subungal hematoma combined with nail bed laceration and the prognosis of bed nail repair combined with fingernail normal position suture for treatment of subungal hemato- mas. Methods From Febuary 2010 to March 2012, the method of bed nail repair combined with fingernail normal position suture was done for children subungal hematomas in forty - seven cases. There were 28 male and 15 female. The mean age of these patients was 5.7 years （range： 1 to 13 years）. The dominant hand was injured in 17 patients rate （48%）. Dominance could not be determined in 8 （19%） due to their young age. The right hand injury was seen in 25 （58%）. The most frequently injured finger was the middle finger（ 22 eases Ihumb （ 1 doorjamb ,51% ）, ease, 2. the small finger （12 cases, 27.8%）, the ring finger （5 cases,ll.6%）, the index finger （3 cases,6.9%）, the 7%）. All 43 fingers were caused by blunt trauma, including doorjamb of house crush injury in 21 cases （48.8%）, crush injury in 13 cases （30.2%） , stone crush injury in 9 cases （21%）. There were 28 eases had the subungual he- matomas hetween 25% -50% of nail surtaee, hetween50% -75% in8 cases （18.6%）, greater than 75% in7 eases （16.3%）. Fifty - eight percent of the nail bed laceration were in the proximal third, finger away section,and all but five were in the proximal two - thirds. There were 28 eases （65. 1% ） were l ranseverse and aimple lacerations, 15 cases （34.9%） were stellate. Tuft fracture occurred in 16 pa- tients but none of these were displaced or intra - articular. Results All patients were followed with an average follow - up tittle being 7.3 months. Complications occurred in 5 patients. Two newborn fingernails had transverse depression, three fingernails appear rough, hyper- trophy, but the function of the fingers were unaffected. Other patients or parents were satisfied with the appearance and function of the fin- get＇. Conclusion The method of bed nail repair combined with fingernail normal position suture was done for chihtren subungal hematoma is simple, safe and effective. The recovery of the finger function and appearance was satisfactory.