Rock Justin, Kurland Adam, Congiusta Dominick V, Baxi Omkar, Vosbikian Michael M, Ahmed Irfan H
Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Eplasty. 2024 Jun 12;24:e37. eCollection 2024.
Although nail bed injuries are common, there is no consensus on the proper course of treatment in regard to nail plate replacement. Nail plate replacement risks infection and injury of the germinal matrix. It is our hypothesis that functional and cosmetic outcomes of the nail will not differ by nail plate replacement following nail bed repair.
This is a single institution, prospective, randomized control study comparing nail plate replacement versus non-replacement in patients undergoing nail bed repair. Primary outcome included nail growth and cosmesis using the Zook classification system. Secondary outcomes were pain, functional limitation, and patient satisfaction. Statistical significance was set at < .05.
Fifty patients were enrolled, 26 (52%) randomized to the non-replacement group and 24 (48%) to the replacement group. All patients who followed up had nail growth by 4 months after nail bed repair (N = 28). In the non-replacement group 4 patients continued to have pain in the affected nail bed compared with 2 patients in the replacement group ( = .66). One patient in each group reported continued functional limitation related to nail pain ( = 1.00). Patient satisfaction was not statistically different between the groups ( = 1.00). As a result of patient follow- up, we have been able to score 17 patients via the Zook criteria. In the non-replacement group, 3 nails were scored as excellent, 3 very good, 3 good, 1 fair, and 2 poor. In the replacement group, the nail was classified as excellent in 4 patients and very good in 1 patient. There was no difference in the likelihood of these outcomes with regard to treatment group ( = .18). There was moderate agreement between patient satisfaction and the Zook criteria scoring (κ = .45, 95% CI: -0.15-1.00).
Statistical and clinical differences were not identified in regard to cosmesis, pain, functional use of the hand, or patient satisfaction. There are established risks involved in nail plate replacement such as infection and injury to the germinal matrix. If outcomes are not different based on nail plate replacement following nail bed repair, non- replacement may be the preferable treatment option so as to avoid these complications.
尽管甲床损伤很常见，但在甲床修复后甲片置换的恰当治疗方案上尚无共识。甲片置换存在感染和生发基质损伤风险。我们的假设是，甲床修复后进行甲片置换与不进行甲片置换相比，指甲的功能和美观效果并无差异。
这是一项单机构前瞻性随机对照研究，比较甲床修复患者中甲片置换与不置换的情况。主要结局包括使用祖克（Zook）分类系统评估指甲生长情况和美观程度。次要结局为疼痛、功能受限及患者满意度。设定统计学显著性水平为<0.05。
共纳入50例患者，26例（52%）随机分配至不置换组，24例（48%）分配至置换组。所有接受随访的患者在甲床修复后4个月时指甲均有生长（N = 28）。不置换组有4例患者患甲床持续疼痛，置换组有2例（P = 0.66）。每组各有1例患者报告因指甲疼痛导致持续功能受限（P = 1.00）。两组患者满意度无统计学差异（P = 1.00）。由于对患者进行了随访，我们得以根据祖克标准对17例患者进行评分。在不置换组，3枚指甲评为优，3枚为良，3枚为中，1枚为差，2枚为劣。在置换组，4例患者的指甲评为优，1例为良。这些结局在治疗组之间的可能性无差异（P = 0.18）。患者满意度与祖克标准评分之间存在中度一致性（κ = 0.45，95%CI：-0.15 - 1.00）。
在美观程度、疼痛、手部功能使用或患者满意度方面未发现统计学及临床差异。甲片置换存在诸如感染和生发基质损伤等既定风险。如果甲床修复后甲片置换的结局并无差异，不进行置换可能是更可取的治疗选择，以避免这些并发症。
