改良甲沟成形术治疗足大趾嵌甲性甲沟炎

目的探讨改良甲沟成形术与拔甲术治疗足大趾嵌甲性甲沟炎的方法及其疗效。方法实验组25例足大趾嵌甲性甲沟炎患者,施行病侧部分甲板、甲基质、病灶、甲沟及增生组织"V"形切除,再建甲沟。对照组25例施行拔甲,病侧增生肉芽修整与甲面平齐,甲沟不做重建处理。两组均术后抗炎换药处理。观察两组患者的疗效、复发率及并发症发生情况。结果术后随访6个月,改良甲沟成形术者有25例均无复发,拔甲术者16例痊愈,9例复发。结论相对于拔甲术,改良甲沟成形术治疗足大趾嵌甲性甲沟炎,切除病灶彻底,治愈率高,复发率低,有较好的临床应用价值。     

甲基质切除联合甲沟重建在嵌甲型甲沟炎治疗中的应用

嵌甲型甲沟炎是甲沟炎中常见的多发病,由甲沟及趾甲周围皮肤组织遭到感染而引发。患者在行走时,感到十分的疼痛,严重影响患者的生活和工作。嵌甲型甲沟炎主要的临床症状为甲沟及趾甲周围皮肤组织颜色发红、有疼痛感、肿胀,严重的可能出现甲下发炎、积脓以及增生性肉芽肿等[1]。常规治疗多采用抗生素消炎或行拔甲术治疗[2],但病程长、     

微创治疗嵌甲性甲沟炎的临床效果分析

目的 通过分析甲沟缘甲板侧切微创治疗嵌甲性甲沟炎的效果,为今后临床治疗提供参考依据.方法 采用甲沟缘甲板侧切微创术对嵌甲性甲沟炎患者进行治疗,同时与拔甲治疗对照患者进行术后疼痛程度、治疗情况、换药次数、愈合时间的比较.结果 两组患者治疗后疼痛情况分级的构成情况差异有统计学意义(P＜0.05),观察组患者治疗后疼痛程度0级及Ⅰ级患者所占的比例高于对照组.两组患者治疗后随访,观察组治愈率高于对照组(P＜0.05),换药次数少于对照组、愈合时间也短于对照组(P＜0.05).结论 采用甲沟缘甲板侧切微创治疗嵌甲性甲沟炎,可以取得较好的治疗效果.     

116例甲沟炎部分拔甲加清创治疗及护理

目的：探讨针对甲沟炎行部分拔甲术加清除甲床坏死组织的治疗及护理效果。方法：对116例甲沟炎患者做好术前准备及解释工作,手术过程严格无菌操作,术后做好心理护理及健康指导。结果：116例甲沟炎患者术后均未发生伤口感染,术后复发率低。结论：部分拔甲术加清除甲床坏死组织治疗能有效减轻患者疼痛、促进伤口愈合、减少甲沟炎复发。     

31例复发性甲沟炎的诊治体会

目的：针对复发性甲沟炎采取比较合理的治疗手段,减少再次复发的概率。方法：将复发性甲沟炎根据不同类型施以不同的治疗手段。单纯红肿的予以保守治疗,化脓性和肉芽增生性的采用指（趾）甲部分切除,混合真菌感染的采用全甲拔除术治疗。结果：共治疗31例复发性甲沟炎,治愈28例,再次复发3例。结论：正确有效地处理甲沟是减少复发性甲沟炎复发的关键,同时做好甲沟和甲的日常护理可以降低甲沟组织损伤,减少甲沟炎复发。     

改良趾腹重塑手术治疗嵌甲性甲沟炎的疗效观察

嵌甲性甲沟炎为社区外科门诊的常见病及多发病。《医宗金鉴》曰：“甲疽多因剔甲伤，甲长侵肉破成疮，胬肉高突痛难忍……”。在社区门诊中几乎每天遇见此类足痛患者，发病涉及老、中、青各年龄段，其中以老年居多。传统的拔甲术后易复发且远端甲床及趾腹有上翘畸形可能，有文献报道，全甲摘除后嵌甲的复发率在32．0％～78．0％。     

鱼石脂抑菌膏结合手术治疗大学生甲沟炎86例

目的探讨甲沟炎的治疗方法。方法回顾性分析86例甲沟炎患者的治疗结果。患者均先采用鱼石脂抑菌膏外用,待炎性水肿减轻或消失后,采用改良拔甲术治疗。结果所有患者均痊愈,86例中83例获得随访,平均随访周期6个月,其中复发5例,痊愈78例。结论鱼石脂软膏结合手术治疗甲沟炎,效果确切,值得临床推广应用。     

甲沟切除术治疗顽固性嵌甲症疗效观察及护理

目的 探索甲沟切除术治疗顽固性嵌甲症疗效观察及护理.方法 回顾性分析76例行甲沟切除术治疗顽固性嵌甲症的临床资料.结果 76例患者中73例伤口Ⅰ期愈合,无并发症发生;其中1例复发,于术后1个月行再次手术治愈;2例出现伤口渗液感染,经加强换药保守治疗后治愈.经3～24个月随访,效果良好无复发.结论 甲沟切除术创伤小,复发率低, 远期疗效确切,是治疗顽固性嵌甲症的理想方法.如果有针对性地做好术后伤口的换药及护理,可有效防止术后伤口感染,提高疗效.     

甲沟炎的自我治疗

指甲除了远端的游离缘外,其余三边均埋于皮肤皱襞下。两侧的沟状处,称为甲沟。甲沟发炎时,称为甲沟炎。 甲沟炎常由于刺伤、修甲过短、嵌甲等引起。初起于一侧,可渐渐蔓延至全甲沟和甲下。局部红肿明显,但很少有全身症状。 甲沟炎的治疗越早越好。最好在急性炎     

心理干预对局麻下行嵌甲性甲沟炎手术治疗患者的影响

目的比较心理干预对局麻下行嵌甲性甲沟炎手术治疗患者的影响。方法选择自2011年2月-2012年11月手术治疗的嵌甲性甲沟炎患者60例,随机分为实验组和对照组各30例。实验组在常规的术前宣教基础上,全程给予患者心理干预处理;对照组只采用常规的术前护理宣教。比较两组患者术前焦虑评分情况及术中疼痛情况。计量资料用均数±标准差表示,采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果实验组患者术前焦虑评分及术中疼痛程度明显优于对照组。差异均有统计学意义(均P<0.05)。结论对于局麻下手术患者在常规术前护理宣教基础上给予全程心理干预,可以明显降低患者术前焦虑评分及术中疼痛程度,值得临床推广和借鉴。     

Are antibiotics necessary in the treatment of locally infected ingrown toenails?

CONTEXT: A wide variety of generalists and specialists treat locally infected ingrown toenails, with perhaps the most common treatment regimen including resection of the nail border coupled with oral antibiotics. OBJECTIVE: To determine whether oral antibiotic therapy is beneficial as an adjunct to the phenol chemical matrixectomy in the treatment of infected ingrown toenails. DESIGN: We prospectively enrolled healthy patients with infected ingrown toenails. Each patient was randomly assigned to 1 of 3 groups that received either 1 week of antibiotics and a chemical matrixectomy simultaneously (group 1), antibiotics for 1 week and then a matrixectomy (group 2), or a matrixectomy alone (group 3). SETTING: Institutional ambulatory outpatient clinic. PATIENTS: Fifty-four healthy patients with infected ingrown toenails were studied. Patients with immunocompromised states, peripheral vascular disease, or cellulitis proximal to the hallux interphalangeal joint were excluded. Groups were age matched for comparison. RESULTS: Mean healing times for groups 1, 2, and 3 were 1.9, 2.3, and 2.0 weeks, respectively. Subjects receiving antibiotics and a simultaneous chemical matrixectomy (group 1) healed significantly sooner than those receiving a 1-week course of antibiotics followed by a matrixectomy (group 2). There was not a significant difference in healing time between those that received a chemical matrixectomy alone (group 3) and those that received a matrixectomy coupled with a course of oral antibiotics (group 1). CONCLUSION: The use of oral antibiotics as an adjunctive therapy in treating ingrown toenails does not play a role in decreasing the healing time or postprocedure morbidity.     

Treatment of Ingrown Toenail With Proximolateral Matrix Partial Excision and Matrix Phenolization

PURPOSE

Ingrown toenail is one of the most common nail conditions. Although many surgical treatments are described for complicated cases, recurrence of pain and postoperative disability are common. We evaluated the long-term efficacy of proximolateral matrix partial excision followed by chemical matricectomy with phenol.

METHODS

We performed 348 proximolateral partial matricectomies and phenol ablations in 225 patients with stage 2 or 3 ingrown toenail. Patients were examined weekly until full wound healing was achieved and were observed for 24 months to assess the long-term efficacy of the treatment.

RESULTS

Short-term results were good. We observed only 1 recurrence during the 24-month follow-up period, at 8 months. The success rate was therefore 99.7%. No severe complications occurred. Cosmetic results were remarkably good.

CONCLUSIONS

Proximolateral partial matricectomy with phenol ablation is an excellent surgical method for the treatment of ingrown toenails, having low morbidity and a high success rate, even in the long term.Key words: ingrown toenail, onychocryptosis, unguis incarnatus, surgery, phenol, matricectomy     

Patient-Controlled Taping for the Treatment of Ingrown Toenails

Various methods are used to treat ingrown or pincer-like toenails. We developed a novel taping method to prevent topical interruption of the circulation and resulting skin conditions and evaluated it over 14.5 years. We instructed 541 patients or their guardians in the use of the technique. Ingrown toenail symptoms and abnormal nail growth were resolved and no additional therapy was required in 276 patients. The novel taping method was significantly more effective than treatments our patients had received previously. Patient-controlled taping is the first-line treatment for every ingrown or curved toenail seen in our clinic.     

329例股骨干骨折带锁髓内钉内固定术并发症及处理对策

目的　通过对 5年所行 32 9例股骨带锁髓内钉治疗股骨干骨折分析 ,探讨术后并发症及相应处理对策。方法　对 32 9例股骨干骨折患者行带锁髓内钉内固定术 ,其中单纯股骨干骨折 2 94例、股骨干骨折合并转子下骨折 35例。结果　远端锁钉失败 2 1例 (其中 2枚远端锁钉均未锁上 1例、1枚远端锁钉未锁上 12例、锁钉松动退出 5例、断 1枚锁钉 3例 ) ,骨折端劈裂 5例 ,骨折延迟愈合 12例 ,骨不连 3例 ,膝关节屈曲受限 2 3例 ,断主钉 1例。结论　扩髓型带锁髓内钉治疗股骨干骨折 ,疗效肯定 ,但需注意术前选钉合理、术中操作规范、术后康复及时、科学     

完整保留趾甲治疗嵌甲症体会

目的探讨完整保留趾甲的有效治疗方法,从而为嵌甲症的治疗提供新的思路。方法根据病情分度,分别采用利凡诺纱布直接垫入、切开延长甲沟垫入、切除肉芽切开延长甲沟垫入,直至趾甲板远端超出甲皱襞。追踪随访观察。结果本组病例92例(111趾)除1例因湿疹,1例因趾甲板浸渍过于松脆而停用该法,中转手术外,余均取得了满意的疗效。结论以完整保留趾甲为原则,采用利凡诺纱布直接垫入、切开延长甲沟垫入、切除肉芽切开延长甲沟垫入的引导生长方法可取得满意疗效。     

Fluconazole (Fungolon) in the treatment of onychomycoses

Onychomycoses are fungal infections of the hand and foot nails, caused by dermatophytes, yeasts and molds. These conditions are difficult to treat, spontaneous remissions are rare and recurrences are not infrequent. AIM: The present study aimed at establishing the efficacy of pulse fluconazole therapy (200 mg once weekly for 4 months) in cases of hand nails infections and 200 mg once weekly for 6 months in cases of feet nail infections. MATERIAL AND METHODS: The study comprised 36 patients--23 with hand onychomycosis and 13 with feet onychomycosis (patients' age ranging from 22 to 67 years). More than 25% of the nail bed was affected in all cases. Diagnosis was based on direct microscopy of KOH treated specimens and by culturing on Sabouraud medium. RESULTS: Treatment outcome was categorized as follows: clinical cure--in 91.3% of the cases with hand onychomycosis and improvement--in 8.7% of the cases; eradication of fungal infection--in 95.6% of the cases. Feet onychomycosis--clinical cure--61.5% of the patients, improvement--in 38.5% and eradication of fungal infection--in 69.2 % of the cases. Fluconazole (Fungolon) has only been recently used in the treatment of nail fungal infections. So far, no standard dosage has been established. CONCLUSIONS: On the basis of the accumulated evidence it is concluded that pulse fluconazole (Fungolon) therapy--200 mg once weekly is effective and safe. However, for better disease outcome, especially in cases of foot nail infections--dosage of 300 mg once weekly and 300-450 mg once weekly (if molds are the offending agents) is recommended.     

单侧上肢损伤患者专用指甲钳的设计与应用

目的探讨解决单侧上肢损伤患者自己修剪健侧肢体指甲的方法。方法使用普通指甲钳、专用胶水、小塑料板、防滑胶垫制作＂单侧上肢损伤患者专用指甲钳＂。结果 ＂单侧上肢损伤患者专用指甲钳＂可以解决上肢损伤的患者自己修剪健侧肢体指甲的难题。结论使用＂单侧上肢损伤患者专用指甲钳＂可以提高单侧上肢损伤患者的自理能力,增强患者的自信心。     

腰椎弓根螺钉进钉点和一次置钉率的研究

目的 探讨不同的置钉方法对腰椎弓根进钉点定位和一次置钉的影响。方法 分析105例患者共462个椎弓根螺钉的内固定应用情况，比较5种定位方法一次置钉成功率的差异。结果 462例均安全地置入椎弓根螺钉，术后X片显示螺钉位于椎弓根中部322例，位于椎弓根下部58例，位于椎弓根上部82例。四象限定位法置钉一次成功率达86．9％，同其他4种定位法比较有显著性差异（P〈0.01）。结论 四象限定位椎弓根点定位准确，显露容易，是一种简单、有效、实用的进钉方法。     

Biomechanical investigation of titanium elastic nail prebending for treating diaphyseal long bone fractures

This study numerically investigated the deformation of titanium elastic nails prebent at various degrees during implantation into the intramedullary canal of fractured bones and the mechanism by which this prebending influenced the stability of the fractured bone. Three degrees of prebending the implanted portions of the nails were used: equal to, two times, and three times the diameter of the intramedullary canal. Furthermore, a simulated diaphyseal fracture with a 5-mm gap was created in the middle shaft portion of the bone fixed with two elastic nails in a double C-type configuration. End caps were simulated using a constraint equation. To confirm that the simulation process is able to present the mechanical response of the nail inside the intramedullary, an experiment was conducted by using sawbone for validation. The results indicated that increasing the degrees of nail prebending facilitated straightening the nails against the inner aspect of canal after implantation, with increase in stability under torsion. Furthermore, reducing nail prebending caused a larger portion of the nails to move closer to the loading site and center of bone after implantation; the use of end caps prevented the nail tips from collapsing and increased axial stability. End cap use was critical for preventing the nail tips from collapsing and for increasing the stability of the nails prebent at a degree equal to the diameter of the canal with insufficient frictional force between the nail and canal. Therefore, titanium elastic nail prebending in a double C-type configuration with a degree three times the diameter of the canal represents a superior solution for treating transverse fractures without a gap, whereas that with a degree equal to the diameter of the intramedullary canal and combined with end cap use represents an advanced solution for treating comminuted fractures in a diaphyseal long bone fracture.     

股骨重建钉内固定治疗股骨转子骨折合并同侧股骨干骨折30例临床分析

目的探讨应用股骨重建钉内固定治疗股骨转子骨折合并同侧股骨干骨折的临床疗效。方法对30例患者使用股骨重建钉内固定治疗,对采用闭合穿钉或小切口复位穿钉手术的疗效进行回顾性分析。结果患者均获得随访,时间为6～24个月。股骨转子间骨折平均愈合时间为51个月,股骨干骨折平均愈合时问为7个月,髋膝关节活动良好,无股骨头坏死征象。结论股骨重建钉是目前治疗股骨转子骨折合并同侧股骨干骨折有效的方法之一。