急诊手外伤甲床缺损多种修复方法的个性化选择

Nail bed defect of hand trauma emergency repair methods of individual choice

目的：探讨急诊手外伤甲床缺损多种修复方法的个性化选择的临床疗效。方法：根据急诊手外伤甲床缺损情况,综合患者条件及要求,进行个性化手术方法的选择,对182例手外伤甲床缺损患者分别采用甲床断层转位修复、足趾甲床断层切取游离移植（包括拇甲瓣）和指骨钻孔、VSD负压封闭引流术的方法,急诊行手外伤甲床缺损的修复。结果：本组182例,行甲床断层转位修复共74例,72例甲床成活并愈合,2例甲床部分成活,成活率为97.3%,采用足趾甲床断层切取游离移植（包括拇甲瓣）共46例,45例甲床成活,1例因并发感染甲床未成活,成活率为97.8%,应用指骨钻孔、VSD负压封闭引流术修复甲床共62例,61例甲床完全愈合,1例甲床未完全愈合,经换药后完全愈合,成活率为98.4%,经以上修复方法成活的甲床组织生长良好,再经换药一周左右均愈合并形成甲床组织。住院时间13-18 d,平均15.5 d,随访时间3~6个月,甲床血供好,均可见指甲生长,外观良好,功能满意。结论：综合甲床缺损情况、患者条件及要求选择最佳的个性化修复方法,对于基层手外科医院面对急诊手外伤甲床缺损的快速有效地处理有着重要意义。

Objective To evaluate a variety of emergency hand trauma nail bed defect repair methods of the clinical curative effect of individual choice. Method According to the emergency hand trauma nail bod defect situation,comprehensive patient conditions and require- ments,personalize the choice of surglcal methods, nail bed defect in 182 cases of hand trauma patients with nail bed fault dislocation repai- ring foot nails bed fault cut free transplantation （ including thumb nail flap） and finger the VSD dosed negative pressure drainage drilling method, the emergency line of hand trauma nail bed defect repair. Results Group 182 examples,line nail bed fault dislocation repair, a total of 74 cases,72 cases of nail bed survival and healed,2 cases of nail bed part of survival,the survival rate was 97.3% ,taking free transplan- tation using foot nail bed fault （including the thumb nail flap）, a total of 46 cases,45 eases of nail bed survival, 1 case of nail bed did not survive through concurrent infection,the survival rate was 97. 8%, and application of finger bone drilling the VSD closed negative pressure drainage to repair nail bed,a total of 62 cases,61 cases of nail bed healed completely, 1 case of nail bed not completely heal,healed completely after dressing, the survival rate was 98.4%, more than the repair methods of tissue survival of nail bed was good, then through apply- ing a week or so were healing and formation of nail bed organization 13 - 18 days of hospital stay, average hospital stay 15.5 days,follow -up of 3 - 6 months time,the nail bed good blood supply, were visible nails. Conclusion Comprehensive nail bed defect of patients condition and requirement to choose the best personalized repair methods,for grassroots hospitals in the face of nail bed defect of hand trauma emergency quickly and efficiently handle has important significance.