甲沟炎手术怎么做？一篇文章跟你说清楚！！！

足科刘医生

发布于 2024-04-10 · 浏览 1.1 万 · IP 河北河北

这个帖子发布于 1 年零 10 天前，其中的信息可能已发生改变或有所发展。

相信看过我之前文章的小伙伴都清楚，大部分的甲沟炎都可以保守治疗得到痊愈。但是，这个周期一般是比较长，对于想快速得到恢复，或者重度甲沟炎患者我们可以采用手术的方法来治疗。

先看文章是怎么说的：

这篇文章是一篇关于内生甲（Ingrown Toenail Management）的临床综述文章，发表在《美国家庭医师》（American Family Physician）2019年8月1日的期刊上。

SURGICAL THERAPY

The goal of surgical intervention is to remove the interaction between the nail plate and the nail fold to eliminate

local trauma and foreign body reaction . Surgical techniques involve removing the pressure of the nail

plate on the nail fold by excising all or part of the nail plate

or by excising all or part of the nail fold.2

Surgical procedures for ingrown nails include the following: partial nail avulsion (Ross procedure) with or without

partial matrixectomy; wedge excision, wedge segmental

excision, or wedge resection with nail matrix destruction

(Winograd procedure); total nail avulsion with or without

excision of any granuloma with or without total (chemical or

surgical) excision of the matrix (Zadik procedure); rotational

flap technique of the nail fold; or radical nail-fold excision

(Vandenbos procedure). Surgical procedures are supported

by minimal comparative data. In the Cochrane review, one

study showed no significant difference in recurrence with

nail-edge excision and total avulsion of the nail.

Lessrecurrence after 12 months with wedge resection (risk ratio = 0.19;

95% CI, 0.05 to 0.80) and radical excision of the nail fold (risk

ratio = 0.17; 95% CI, 0.04 to 0.72) than with the rotational

flap technique was also noted.

Prevention of recurrence

between wedge resection and radical excision of the nail fold

showed no significant difference after 12 months.

The most common procedure for treating locally ingrown

toenails is partial avulsion of the lateral edge of the nail

plate sometimes followed by lateral horn matrixectomy by

phenolization or surgical excision of the lateral horn of the

nail matrix, both of which are equally effective. When possible, partial nail-plate avulsion is

preferred to complete avulsion because it minimizes trauma

to the adjacent tissues.

Most of the lateral fold redness associated with onychocryptosis results from the foreign body reaction. After the

ingrown portion of the nail is removed and matrixectomy

is performed, any localized inflammation and/or infection

should resolve without the need for antibiotic therapy with

similar healing times. Thus, oral or topical antibiotic

treatment is not recommended unless clear, widespread cellulitis is present.

翻译：

手术治疗方案：

手术干预的目的是消除甲板与甲襞之间的相互作用，以消除局部创伤和异物反应。外科技术包括通过切除全部或部分甲板或切除全部或部分甲襞来消除甲板对甲襞的压力。

内生指甲的手术包括:部分指甲切除术(Ross手术)伴或不伴部分基质切除术;楔形切除、楔形部分切除或楔形切除合并甲基质破坏(Winograd手术);甲全撕脱，伴有或不伴有肉芽肿切除，伴有或不伴有基质全(化学或外科)切除(Zadik手术);甲襞的旋转皮瓣技术;或根治性甲襞切除(Vandenbos手术)。极少的比较数据支持外科手术。在Cochrane综述中，一项研究显示甲缘切除和甲全撕脱在复发率上无显著差异。楔形切除12个月后复发率较低(风险比= 0.19;95% CI, 0.05 ~ 0.80)和甲襞根治性切除(风险比= 0.17;95% CI(0.04 ~ 0.72)，与旋转皮瓣技术相比也有所提高。楔形切除与根治性切除甲襞12个月后预防复发的效果无显著差异。

治疗局部内生趾甲最常见的方法是甲板外侧边缘部分切除，有时采用酚化法切除外角基质或手术切除外角基质，这两种方法效果相同。在可能的情况下，部分甲板撕脱优于完全撕脱，因为这样可以减少对邻近组织的创伤。

大多数与甲爪塌陷相关的侧襞发红是由异物反应引起的。在指甲的内生长部分被移除并进行基质切除术后，任何局部炎症和/或感染都不需要抗生素治疗，愈合时间相似。因此，口服或局部抗生素治疗不推荐，除非明确，广泛的蜂窝织炎存在。

一、Ross手术