自体真皮移植配合甲板替代物修复部分甲床缺损的临床研究  

Clinical study of nail bed defect reconstruction by autologous dermis grafts combined with deck substitute

作　　者：姚喜州 何县委 卜晓凡 张新潮 Yao Xizhou;He Xianwei;Bu Xiaofan;Zhang Xinchao(Department of Orthopedics,Jinshan Hospital of Fudan University,Shanghai 201508,China;Department of Paedology,Jinshan Hospital of Fudan University,Shanghai 201508,China)

机构地区：[1]复旦大学附属金山医院骨科,上海201508 [2]复旦大学附属金山医院儿科,上海201508

出　　处：《创伤外科杂志》2021年第10期757-759,共3页Journal of Traumatic Surgery

基　　金：上海市金山区科委课题(2020-3-18)。

摘　　要：目的探讨自体真皮配合甲板替代物修复手指部分甲床缺损的临床效果。方法回顾性分析2018年7月—2020年1月复旦大学附属金山医院骨科收治因创伤致部分甲床缺损、指骨外露患者14例共15指,男性9例,女性5例;年龄20~58岁,平均37.2岁。刀切伤5例,电锯伤2例,冲压伤3例,碾压伤4例。所有患者行急诊清创后,一期进行取前臂真皮移植,同时配合甲板替代物加压覆盖,修复缺损甲床。供区直接缝合,术后随访观察指甲生长情况。结果1例患者因创面感染于术后5d去除甲板替代物,经换药后创面愈合,因部分皮片坏死,瘢痕愈合,新生指甲不光滑,外形欠佳;余13例14指创面愈合良好,于术后2周拆除缝线及甲板替代物。门诊随访5~16个月,平均10.3个月。患者指甲生长平整光滑,外形对称,未出现指甲与甲床分离现象;未出现患指疼痛、握力或捏持力减退症状。供区全部愈合,术后2周拆除缝合线,留有线性瘢痕。结论应用自体真皮配合甲板替代物修复部分甲床缺损,操作简单,取材方便,费用低廉,临床效果良好。Objective To explore the clinical effect of autologous dermis combined with deck substitute on partial nail defect.Methods A retrospective analysis was conducted in 14 cases of 15 fingers with partial nail bed defect and bone exposure who were admitted to the Department of Orthopedics,Jinshan Hospital Affiliated to Fudan University from Jul.2018 to Jan.2020.There were 9 males and 5 females,with a mean age of 37.2 years(range 20-58 years).There were 5 cases of knife cut injuries,2 cases of electric saw injuries,3 cases of punching injuries,and 4 cases of crushing injuries.All patients received primary repair with autologous dermal grafts and deck substitute pressure coverage after debridement,to repair the defect nail bed.The donor site was sutured directly,and the nail growth was observed after follow-up.Results After operation,1 patient had the nail plate substitute removed 5 days after the operation due to wound infection,and the wound healed after changing the dressing.However,due to the necrosis of part of the skin,the scar healed,the new nails were not smooth and the appearance was not good.The wounds of 14 fingers of the remaining 13 cases healed well,and all sutures and nail plate substitutes were removed 2 weeks after surgery.The patients were followed up for 5-16 months,with an average of 10.3 months.The nail growth was smooth and symmetrical,and there was no separation of the nail from the nail bed.None of the patients had symptoms of finger pain,grip strength or reduced pinching strength.The donor sites all healed,and the suture was removed 2 weeks after the operation,leaving a linear scar.Conclusion The application of autogenous dermis combined with deck substitute to repair partial nail bed defect is simple,easy to obtain,and has low cost and good clinical effect.

关 键 词：甲床缺损 自体真皮 甲板替代物 

分 类 号：R658.2[医药卫生—外科学]