摘要
目的 探讨手指甲床损伤的分型与治疗方案的选择.方法 2006年1月-2009年12月,对我院105例120指甲床损伤患者进行分析,按照损伤程度将其分为三型,Ⅰ型（甲床无缺损）40指,Ⅱ型（部分性甲床缺损）40指,Ⅲ型（完全性甲床缺损）40指,Ⅰ～Ⅱ型根据损伤特点又分为A、B、和C三个亚型,其中Ⅱ型损伤的A和B亚型又分出两个次级亚型.根据甲床损伤不同分型,分别采用拔甲术、甲床缝合、各种带蒂皮瓣和足趾甲皮瓣移植等进行修复.结果 Ⅰ型缺损中Ⅰ C型共3例出现甲床坏死,改行皮瓣修复后成活,Ⅱ和Ⅲ型损伤采用皮瓣或趾甲皮瓣修复全部成活.随访3～9个月,修复与再造的甲床指甲生长良好,皮瓣外观满意.结论 手指甲床损伤的分型有助于治疗方案选择及预后的判断,带蒂皮瓣是Ⅱ和Ⅲ型甲床损伤修复的有效方法,而足趾甲床皮瓣是修复ⅡB2和Ⅲ型甲床损伤较理想的治疗方法.
Objective To study classification and treatment of nail bed injuries. Methods From January 2006 to December 2009, 120 fingers in 105 patients with nail bed injuries were treated in our hospital. Based on the shape and size of the defects, the injuries were classified into typeI, Ⅱ, and Ⅲ corresponding to integrity （n=40）, partial loss （n=40）, and complete loss （n=40）. The injuries of type I and type Ⅱwere classified into subtype A, B, and C. The injuries of subtype A and B of type Ⅱ were classified into two sub-subtypes, respectively. Nail plate removal, nail bed repair, and coverage of the defect using a pedicle flap, and/or toe-to-finger nail bed transfer, etc. were performed according to the types of the injuries. Results In type IC group, nail bed necrosis was noted in 3 digits, which was repaired with flap transfer. Coverage of nail bed was achieved by using either pedicle flap or toe-to-finger nail bed transfer in type Ⅱ or Ⅲ group. At the final following-up of 3 to 9 months, smooth nail plate was observed in those digits received nail bed repair or reconstruction. The contour of the flap was acceptable in the digit received flap tranfer. Conclusion Classification of the nail bed injuries is useful for selection of the techniques and prognosis of the outcomes. Pedicle flap transfer is an reliable technique for the treatment of the nail bed injuries of type Ⅱ and Ⅲ. Toe-to-finger nail bed transfer is reliable for tvoe ⅡB2 and Ⅲ nail bed injuries.
出处
《实用手外科杂志》
2010年第3期182-184,共3页
Journal of Practical Hand Surgery
关键词
手指
甲床
损伤
分型
皮瓣
Finger
Nail bed
Injury
Type
Flap
