趾侧方切口治疗趾甲沟炎的美学和功能学评价

The aesthetics and function of a surgical method with lateral incision in treating the ingrown toenail and paronychia

目的 探讨采用趾甲根侧方切口治疗嵌甲并甲沟炎的美学和功能学结果,并与传统Winograd术式进行比较.方法 收集2013年8月至2015年6月期间山东大学第二医院共收治的甲沟炎患者77例（89趾）,年龄15-58岁.其中37例（42趾）采用Winograd术式,40例（47趾）采用侧方切口术式,即采用不破坏甲皱襞的侧方切口切除甲基质.通过比较两组患者恢复正常活动的时间、感染率和复发率、疼痛VAS评分及患者对趾外形的满意度VAS评分,对手术的功能学及美学疗效进行评价.结果 所有患者术后平均随访8.6个月,侧方切口治疗组患者术后恢复正常活动的时间为（5.3±0.5）天,Winograd方法组患者术后恢复正常活动的时间为（7.3±0.6）天,差异有统计学意义（P〈0.05）.且术后感染率侧方切口治疗组明显低于Winograd手术组（P〈0.05）.术后3天,侧方切口治疗组疼痛VAS评分明显低于传统组（P〈0.05）,而术后第1、6个月,两组差异无统计学意义（P〉0.05）.侧方切口治疗组和传统术式组外形满意度VAS评分分别为（9.2±0.6）分、（7.1±0.7）分,差异有统计学意义（P〈0.05）.结论 采用甲皱襞基底侧方切口切除甲基质,不切除或切开甲皱襞,保留甲沟,术后患者可早期恢复活动,减轻术后疼痛,术后感染率低,且可获得满意的甲外形.

Objective To investigate the advantages of a novel method with lateral incision in treating the ingrown toenail and paronyehia in the aspect of aesthetics and function, compared with the traditional Winograd method. Methods From August 2013 to June 2015, 77 cases （89 toes） with 15-58 years were involved in the study. 37 cases （42 toes） were treated with Winograd method and other 40 eases （47 toes） were treated with a method using lateral incision without cutting the nail fold. The time of returning to normal aetivities, infection rate, reeurrenee rate, pain VAS seore and shape satisfaetion VAS score were evaluated to display the effect of the both methods in aesthetics and function. Results All patient were followed up with an average of 8.6 months. The patients treated with the novel method returned to normal activities after （5.3± 0.5）d post-surgery, with is much shorter than the Winograd method （P〈0.05）. And the infection rate in the novel method group was also lower than the Winograd method group （P〈O.05）. At 3 days post-surgery, the pain VAS score in Winograd method group was higher （P〈0.05）, but the difference of pain VAS score disappeared after 1 and 6 months post-surgery （P〉0.05）. The shape satisfaction VAS score in the novel method group and the winograd method group were （9.2 ± 0.6） and （7.1 ± 0.7）, which had signifieant difference statistically （P〈0.05）. Conclusion The novel method without incising the nail fold reserves the nail groove and brings faster recovery to normal activities, less pain, lower infection rate and more satisfactory toenail shape.