甲弧影以远弧形切口联合甲模板回植在治疗甲下血管球瘤中的应用  

Application of distal arc-shaped incision of lunula combined with nail template replantation in the treatment of subungual glomus tumor

作　　者：陈伟健 刘彬[1] 鹿亮 曾建学 李多玉 Chen Weijian;Liu Bin;Lu Liang;Zeng Jianxue;Li Duoyu(Department of Orthopedics,the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital),Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院(安徽省立医院)骨科,合肥230001

出　　处：《中华整形外科杂志》2023年第3期266-272,共7页Chinese Journal of Plastic Surgery

摘　　要：目的:探讨采用甲弧影以远弧形切口联合甲模板回植治疗甲下血管球瘤的可行性及疗效。方法:回顾性分析2019年3月至2021年6月中国科学技术大学附属第一医院骨科治疗的甲下血管球瘤患者的临床资料。所有患者在拔除指甲后,采用甲弧影以远弧形切口入路切开甲床,暴露瘤体后完整切除,切开的甲床瓣原位复位,不予缝合,选择使用5 ml注射器针筒或原甲板制作甲模板,戳引流孔,回植覆盖于甲床表面,三点缝合加压固定,常规换药,3周后拆除甲模板。记录患者术前及术后1个月疼痛视觉模拟法(VAS)评分,并随访观察甲床愈合、疼痛改善、指甲生长及肿瘤复发等情况。手术前后VAS评分以M(Q1,Q3)表示,采用Mann-Whitney U检验进行分析,P<0.05为差异有统计学意义。结果:共纳入37例患者,男5例,女32例;年龄18~67岁,平均39岁。术后病理均确诊为甲下血管球瘤,所有患者均获得随访,随访时间6~36个月,平均22个月,术后换药均无明显痛感,拆除甲模板后见甲床平整干燥,无明显瘢痕形成,术后切口均一期愈合,新生指甲平整光滑、外观满意,疼痛症状均消失,随访期间无复发。术前VAS评分为5.0(4.5,6.0)分,术后1个月VAS评分为0.0(0.0,0.0)分,差异具有统计学意义(Z=-7.57,P<0.001)。结论:甲弧影以远弧形切口治疗甲下血管球瘤,能有效保护甲床生发基质,瘤体暴露充分,可彻底切除,复发率低,同时结合甲模板回植可显著减轻甲床瘢痕形成,有效预防术后指甲畸形,方法简单,易于操作,临床疗效显著。Objective To investigate the feasibility and efficacy of distal arc-shaped incision of lunula combined with nail template replantation for the treatment of subungual glomus tumor.Methods The clinical data with subungual glomus tumor treated in the Department of Orthopedics of First Affiliated Hospital of the University of Science and Technology of China from March 2019 to June 2021 were retrospectively analyzed.Each patient removed the nail,the nail bed was cut into by a distal arc-shaped incision of the lunula.After the tumor was exposed,the tumor was resected completely,the nail bed flap was reduced in situ without suturing.The nail template was made by using the 5 ml syringe barrel or the original nail and poked the drainage holes in it,then the nail template was covered on the nail bed surface,three-point suturing and pressurized fixation,routine dressing change,and the nail template was removed 3 weeks after the procedure.The visual analogue scale(VAS)of pain was recorded preoperative and one month after the operation,and nail bed healing,pain improvement,nail growth,and tumor recurrence were observed.VAS scores before and after surgery were expressed as M(Q1,Q3),and analyzed by Mann-Whitney U test,P<0.05 was considered statistically significant.Results A total of 37 patients were enrolled,including 5 males and 32 females.The age ranged from 18 to 67 years old,with an average of 39 years old.All patients were confirmed as subungual glomus tumors by postoperative pathology,they were followed up for 6 to 36 months,with an average of 22 months.All of the patients had no obvious pain during the dressing change,after removing the nail template,the nail bed was flat and dry,and no obvious scar formation was found.All postoperative incisions were healed in one stage,the new nail recovered smoothly with a satisfactory appearance,the pain symptoms disappeared completely,and also no recurrence occurred during follow-up.The preoperative VAS score was 5.0(4.5,6.0),the VAS score one month after the operation was 0.0(0.0,

关 键 词：血管球瘤 指甲 指甲疾病 甲床 甲弧影 甲模板 

分 类 号：R732.2[医药卫生—肿瘤]