中国麻风皮肤病杂志 ›› 2025, Vol. 41 ›› Issue (7): 498-502.doi: 10.12144/zgmfskin202507498

• 临床研究 • 上一篇    下一篇

双侧甲皱襞切除联合远端软组织减容术治疗重度慢性拇趾甲沟炎疗效评价

李振东1,周海超1,赵有光1,夏江1,李兵2,杨云峰2   

  1. 1同济大学附属同济医院骨科，上海，200065；2上海交通大学医学院附属瑞金医院骨科，上海，200025
  • 出版日期:2025-07-15 发布日期:2025-07-04

Bilateral perionychial flap excision combined with distal soft tissue reduction technique for treating severe chronic paronychia of the great toe

LI Zhendong1, ZHOU Haichao1, ZHAO Youguang1, XIA Jiang1, LI Bing2, YANG Yunfeng2   

  1. 1 Department of Orthopedics, Tongji Hospital Affiliated to Tongji University, Shanghai 200065, China; 2 Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2025-07-15 Published:2025-07-04

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摘要： 目的：明确双侧甲皱襞切除联合远端软组织减容术治疗重度慢性拇趾甲沟炎的临床疗效。方法：收集2021年1月至2022年12月于我院骨科就诊的慢性重度甲沟炎患者的临床资料。均采用软组织减容术治疗，术后随访12个月。记录术前、术后1个月、12个月疼痛视觉评分（VAS）和皮肤病生活质量量表评分（DLQI），记录患者复发情况、术后并发症情况和满意度。结果：纳入55例患者共67趾，平均(23.1±10.3)岁，男39例，女16例；单侧患病43例，双侧患病12例，左侧35趾，右侧32趾。术后1、12个月VAS评分分别为（1.02±0.12）和（0.10±0.05），DLQI评分分别为（6.75±2.13）和（1.45±0.87），较术前VAS（6.11±0.89）和DLQI（16.23±3.34）明显下降（P＜0.001）。术后3例出现伤口感染及炎症反应，经反复换药及抗生素治疗后痊愈。术后2例出现复发，存在趾甲包埋和疼痛等不适，使用Ω钢丝及棉花填塞一段时间后症状好转。术后1、12个月患者满意度分别为81.8%和92.7%。结论：双侧甲皱襞切除联合远端软组织减容术治疗重度慢性拇趾甲沟炎疗效确切，术后并发症发生率和复发率低，患者满意度高。

关键词: 甲沟炎, 外科手术, 软组织减容, 嵌甲

Abstract: Objective: To study the clinical efficacy of bilateral perionychial flap excision combined with distal soft tissue reduction in the treatment of severe chronic paronychia of the great toe. Methods: Clinical data of patients with chronic severe paronychia who visited the Department of Orthopedics at Tongji Hospital of Tongji University from January 2021 to December 2022 were collected. All patients were treated with soft tissue reduction technique and followed up for 12 months postoperatively. Preoperative and postoperative visual analogue scale (VAS) scores for pain and Dermatology Life Quality Index (DLQI) scores were evaluated, along with patient recurrence, postoperative complications, and personal satisfaction. Results: A total of 55 patients with 67 affected toes were analyzed, including 39 males and 16 females, with an average age of (23.1±10.3) years. Among them, 43 had unilateral involvement, and 12 had bilateral involvement, with 35 toes affected on the left side and 32 on the right side. The VAS scores at first and twelfth months after the operation were (1.02±0.12) and (0.10±0.05), and the DLQI scores were (6.75±2.13) and (1.45±0.87) respectively, with significant differences compared to the preoperative VAS (6.11±0.89) and DLQI (16.23±3.34) (Ps＜0.001). After the operation, wound infection and inflammatory response occurred in 3 cases, and they recovered after repeated dressing changes and antibiotic treatment. Recurrence occurred in 2 cases after the operation, with symptoms of nail entrapment and pain, and the symptoms improved after a period of treatment with Ω wire and cotton filling. The patient satisfaction at first and twelfth months after the operation was 81.8% and 92.7% respectively. Conclusions: Bilateral perionychial flap excision combined with distal soft tissue reduction is an effective treatment for severe chronic paronychia of the great toe, with low rates of postoperative complications and recurrence, and high patient satisfaction.

Key words: paronychia, surgical procedures, soft tissue reduction, acronyx