青少年和成年人嵌甲的病因分析及其改良手术方法探讨

Etiological Analysis of Imbedded Nail in Adolescents and Adults and Its Modified Surgical Treatment

目的:探讨青少年及成年人嵌甲的病因,并对应用彻底切除两侧甲生发层的甲襞成形术治疗嵌甲的有效性进行分析。方法:选择2015年1月-2016年12月笔者医院收治的顽固性嵌甲症患者68例,其中青少年组:36例,成年组:32例;部位:单足第一趾60例,双足第一趾8例;病程最短2个月,最长3年,平均4个月;复发次数最少1次,最多6次,平均3次。分析青少年及成年嵌甲发病原因,并对所有患者采用彻底切除两侧甲生发层的甲襞成形术进行治疗。结果:青少年嵌甲致病原因主要为穿不合适、过紧的鞋子,多汗;成年嵌甲致病原因主要为修剪趾甲不当、创伤性甲损伤。68例患者中,青少年组36例,术后伤口愈合时间(6±1.38)d,成年组32例,术后伤口愈合时间(8±1.68)d。青少年组随访3~24个月,平均19个月,优良率达97.2%,成年组随访2~22个月,平均17个月,优良率达93.8%。术后拇趾外露甲体宽度患侧为(16.36±0.17)mm,术前拇趾外露甲体宽度为(16.58±O.36)mm,术后趾甲形态满意。结论:青少年和成年嵌甲致病主要原因各不相同。彻底切除两侧生发层的甲襞成形术治疗嵌甲效果满意,可获得较好的美观外形。

Objective To investigate the etiology of nesting nail in adolescents and adults,and to study the effectiveness of nail plica plasty in the treatment of nesting nail with complete removal of both sides of the nail germinal layer.Methods From January 2015 to December 2016,68 cases of intractable nail-embedding were treated in our hospital,including 36 cases in adolescent group,32 cases in adult group,60 cases in the first toe of one foot and 8 cases in the first toe of both feet,in which there were 36 cases in the adolescent group and 32 cases in the adult group.The course of disease was the shortest 2 months,the longest 3 years (average 4 months),the number of recurrence at least once,the most 6 times,the average 3 times.The causes of nesting nail in adolescents and adults were analyzed,and all patients were treated with nail plica plasty with complete removal of bilateral nail germinal layer.Results The main causes of juvenile nail implantation were improper wearing,tight shoes and excessive perspiration,and the main causes of adult nail implantation were improper trimming of toenails and traumatic nail injury.Among the 68 patients,the postoperative wound healing time of 36 patients in the adolescent group was (6.00±1.38) days,and that of 32 patients in the adult group was (8.00±1.68)days.Thirty-six cases in the adolescent group were followed up for 3~24 months,with an average of 19 months.There were 32 excellent cases,3 good cases and 1 poor case,with an excellent and good rate of 97.2%.There were 32 cases in the adult group,with an average of 17 months,with an excellent and good rate of 23 cases,7 good cases and 2 poor cases,with an excellent and good rate of 93.8%.Postoperative body width of lateral toes exposed armor is (16.36±0.17) mm,exposed a body width for preoperative toe (16.58±0.36)mm,satisfactory postoperative toenail morphology.Conclusion The main causes of nesting diseases in adolescents and adults are different.Nail plica reconstruction with complete excision of the germinal layer of both sides is effective in the treatment of nail inlay,and good appearance can be obtained.