甲床断层移植一期修复甲床缺损的疗效观察  

The curative effect of nail bed transplantation for repairing nail bed defect in one stage

作　　者：黄卫国[1] 李玉民[1] 李治[1] 

机构地区：[1]北京大学民航总医院骨科,100025

出　　处：《中华骨科杂志》2005年第4期208-210,共3页Chinese Journal of Orthopaedics

摘　　要：目的探讨甲床断层移植一期修复甲床缺损的治疗方法,综合评价其功能恢复情况。方法2000年2月至2003年12月,对26例33指甲床部分或大部分缺损病例进行治疗,男21例24指,女5例9指;年龄18～39岁,平均26.5岁;左手17例20指,右手9例13指;拇指7指,示指13指,中指9指,环指4指。均采用同指残留甲床或第一、二、三足趾中厚断层甲床移植方法修复。甲床缺损≥5mm但小于同指甲床面积的1/3时,在指根麻醉或臂丛麻醉下,上指根橡皮止血带,切取同指中厚断层甲片进行移植。甲床缺损大于同指甲床面积的1/3至甲后皱襞以远甲床全部缺损或同时合并两指甲床缺损时,供指采用趾神经阻滞麻醉,趾根橡皮止血带下,切取第一、二、三足趾断层甲片进行移植。结果所有患者均获得随访,随访时间6～30个月,平均17个月。无一例患者发生感染,移植全部成活,指甲生长平整无明显畸形,无疼痛,甲板被覆恢复时间短。术后根据吕桂欣等方法进行疗效评定,优良23例29指,占87.9%;差3例4指,占12.1%。结论甲床缺损中厚断层甲床移植方法操作简单,指甲生长外形良好,畸形发生率低。Objective To investigate the efficacy of repairing finger nail bed defects by split-thickness nail bed grafts in one stage, and evaluate the functional recovery of nail beds comprehensively. Methods From February 2000 to December 2003, 33 fingers with nail bed defect in 26 patients (7 thumbs, 13 index fingers, 9 middle fingers, 4 ring fingers) were repaired with middle thickness grafts of nail bed harvested from the residual nail beds of the same fingers or from nail beds of 1st, 2nd and 3rd toes. Brachial plexus block or regional anesthesia was used. When the area of nail bed defect area was less than one third of the nail, the graft was taken from the same finger under rubber tourniquet. In condition of the area of nail bed defect larger than one third of the nail beyond nail plica or two nail bed defects, the grafts were taken from the nail beds of 1st, 2nd and 3rd toes. Results In the study, there were 23 fingers (18 patients) with the nail bed defects area more than 5 mm and less than one third of the nail repaired with the grafts of the same finger nail; there were 10 fingers (8 patients) with the nail bed defects more than one third of the nail beyond the nail plica or two nail bed defects transplanted with toe nail bed. All patients were followed up from 6 months to 30 months with an average of 17 months, all grafts survived very well. No pain, no infection and obvious deformed growth of nail were found, and a sound recovery was obtained in all patients. Excellent and good rates were 87.9% in 23 patients with 29 fingers; poor rate was 12.1% in 3 patients with 4 fingers according to the criteria by Lü Gui-xin. Conclusion The transplantation of middle split-thickness nail bed to repair nail bed defect is simple and easy to operate. The grafted nail can grow in good appearance, and the deformation rate is lower.

关 键 词：甲床缺损 一期修复 断层 疗效观察 神经阻滞麻醉 移植方法 2003年 2000年 橡皮止血带 畸形发生率 治疗方法 恢复情况 臂从麻醉 随访时间 恢复时间 疗效评定 甲生长 无疼痛 平均 足趾 面积 指根 甲片 切取 患者 

分 类 号：R658[医药卫生—外科学]