不同类型甲床缺损的手术修复  

Repairing nail bed defect of different kinds by corresponding operation methods

作　　者：杨涛[1] 张国雷[1] 陈传煌[1] 李楚炎[1] 姚海波[1] 毛仁群[1] 

机构地区：[1]广东医学院附属南山医院手足外科,广东深圳518052

出　　处：《实用手外科杂志》2016年第3期291-294,共4页Journal of Practical Hand Surgery

摘　　要：目的：介绍不同类型甲床缺损的手术治疗方法及临床疗效。方法根据甲床缺损情况，将其分为4度。Ⅰ度：缺损直径小于0.4 cm；Ⅱ度：缺损直径大于0.4 cm，小于同指总甲床面积的3/4；Ⅲ度：缺损面积大于同指总甲床面积的3/4，不合并甲基质缺损；Ⅳ度：完全缺损合并甲基质缺损。2012年6月-2014年12月，对收治的甲床缺损20例26指，根据不同缺损情况，Ⅰ度缺损采用直接显微缝合或依其自行瘢痕愈合；Ⅱ度缺损采用同指断层甲床移植或“邮票”样断层甲床移植；Ⅲ度缺损采用以足趾为供趾的断层甲床移植；Ⅳ度缺损采用吻合血管的趾甲瓣移植。结果所有患者均获得随访,随访时间10～24个月,移植的甲床全部成活,甲板生长平整无明显畸形。根据吕桂欣等方法进行疗效评定，优16指，良6指，差4指，优良率84.6％。结论根据甲床缺损的不同情况采用相应的手术治疗方法，尽可能减少副损伤，达到修复甲床的目的，恢复指甲的形态和功能。Objective To report the different kinds of methods and effect of surgical treatment of nail bed defect. Methods According to the nail bed defect situation, it was divided into 4 degrees. Ⅰdegree：defect diameter was less than 0.4 cm; Ⅱdegree： defect diameter was greater than 0.4 cm and defect area was less than three-quarters of the total area of the nail bed;Ⅲdegree：defect area was greater than three-quarters of the total area of the nail bed without nail matrix damage; Ⅳ degrees： complete nail bed defect with nail matrix damage. 26 fingers of 20 patients with nail bed defect after injury were treated in our hospital from June 2012 to December 2014. According to different defect, direct microscopic suture or scar repair via dressing change was adopted in Ⅰ degree defect; nail bed transplantation or stamp -like nail bed transplantation from injured finger was adopted in Ⅱ degree defect; nail bed transplantation form the toe was adopted in Ⅲ degree defect; vascularized toe nail flap transplantation was used in Ⅳ degree defect. Results All patients were followed up from 10 to 24 months, all the transplanted nail bed were survived, the deck growed flat without obvious deformity. According to the method of GuiXin Lv, excellent and good rates were 84.6%, excellent in 16 fingers, good in 6 fingers, poor in 4 fingers. Conclusion Appropriate surgical treatment method should be used according to the different situation of nail bed defect in order to reduce side injury as far as possible, and achieve the purpose of repairing nail bed, and restoring the morphology and functions of the nails.

关 键 词：甲床缺损 移植 修复 

分 类 号：R658.2[医药卫生—外科学]