Pettine K A, Cofield R H, Johnson K A, Bussey R M
Mayo Graduate School of Medicine, Rochester, Minnesota.
Foot Ankle. 1988 Dec;9(3):130-4. doi: 10.1177/107110078800900307.
When an ingrown toenail is unresponsive to simple treatment methods, surgical treatment options are available. At our institution, 100 patients with 142 affected toes were surgically treated by one of five techniques and observed for a mean of 9.7 years (range, 7.8 to 10.0 years). Plastic nail wall reduction was effective (four of four nail edges) for mild disease. After marginal nail excision with chemical matrix ablation, the recurrence rate was 20% (12 of 61 nail edges); eight required further surgical treatment. Marginal nail excision combined with surgical excision of the associated nail matrix (Heifetz procedure) was more successful: recurrence occurred in only 6% (6 of 95 nail edges), and only one toe required further surgical treatment. For severe nail deformity, nail ablation with matrix excision (Zadik procedure) was followed by recurrence in 33% (three of nine toes); all three required additional surgical treatment. After terminal amputation (Lapidus/Thompson-Terwilliger procedure), the recurrence rate was 12% (2 of 17 toes); only one nail required additional surgical treatment.
当嵌甲对简单治疗方法无反应时，可采用手术治疗方案。在我们机构，100例患者的142个患趾接受了五种技术之一的手术治疗，并平均观察了9.7年（范围为7.8至10.0年）。对于轻度疾病，塑料甲壁切除术有效（4个甲缘中的4个）。化学甲床消融边缘甲切除术后，复发率为20%（61个甲缘中的12个）；8例需要进一步手术治疗。边缘甲切除联合相关甲床手术切除（海费茨手术）更成功：仅6%（95个甲缘中的6个）复发，只有1个趾需要进一步手术治疗。对于严重甲畸形，甲床切除甲消融术（扎迪克手术）后复发率为33%（9个趾中的3个）；所有3例均需要额外手术治疗。末节截肢术（拉皮德斯/汤普森 - 特威利格手术）后，复发率为12%（17个趾中的2个）；只有1个甲需要额外手术治疗。
