儿童甲下外生骨疣的临床诊疗分析

目的分析儿童甲下外生骨疣的临床特点和治疗效果。方法收集首都医科大学附属北京儿童医院骨科2008年1月至2019年9月收治的22例甲下外生骨疣患儿的临床资料。其中,男16例,女6例;年龄为(120.2±34.7)个月,范围为43~182个月;病程为(13.5±10.7)个月,范围为3~48个月。21例的病灶位于趾骨末节,1例位于指骨末节(右手示指)。21例中,左足8例,右足13例;足母]趾14例,第2趾3例,第3趾3例,第4趾1例。平均随访时间为23.5个月,范围为6~57个月。有明确外伤史的患儿4例,有明确感染的5例;18例有趾(指)甲畸形;17例趾(指)甲有压痛。记录患儿甲下外生骨疣的发生部位、趾(指)甲有无畸形、有无压痛、有无外伤史、有无感染、手术方式等。结果22例患儿均接受手术治疗,效果良好,其中Ⅰ型3例,Ⅱ型13例,Ⅲ型6例。术中对27.3%(6/22)的患儿拔甲,72.7%(16/22)的患儿没有拔甲,27.3%(6/22)的患儿修补缝合甲床,若不能直接缝合,则削切正常甲床的薄层组织作为补片修补缝合甲床;4.5%(1/22)的患儿复发并接受二次手术治疗。所有患儿的平均随访时间为23.5个月,范围为6~57个月。所有患儿术后未见足趾或手指坏死、甲沟炎、趾(指)甲变形等并发症,趾(指)甲外观平坦,患儿及家长满意。所有患儿接受手术的足趾或手指均无活动受限、僵硬等功能异常,末次随访时日常活动及运动功能均不受影响,其中有1例患儿甲下骨疣切除术后3个月复发,重新行甲床分离病灶切除术,术后随访12个月未见再次复发。结论儿童甲下外生骨疣是一种少见的良性疾病,多见于足母]趾,可能与外伤有关。手术是有效的治疗方法,根据病灶部位与甲床的关系,选择合适的切口与甲床的处理方式,有助于提高治疗效果。

Clinical diagnosis and treatment of subungual exostosis in children

Objective To summarize the clinical characteristics and treatments of subungual exostosis in children.Methods From January 2008 to September 2019,clinical data were reviewed for 22 hospitalized children with hypothyroidism.There were 16 boys and 6 girls with an average age of(120.2±34.7)(43-182)months.The average course of disease was(13.5±10.7)(3-48)months.The lesion was located in distal phalangeal segment(n=21)and right index finger(n=1).Among 21 cases,the involved foot was left(n=8)and right(n=13).There were great toe(n=14),second toe(n=3),third toe(n=3)and fourth toe(n=1).The mean follow-up period was 23.5(6-57)months.There was a definite history of trauma(n=4)and infection(n=5).There were 18 cases of toe/finger nail deformity.Tenderness was observed in 17 cases of toe(finger).Occurrence site,toe(finger)nail deformity,tenderness,history of trauma,infection and surgical approach were recorded.Results The outcomes of 22 operated cases were excellent.The clinical types were I(n=3),Ⅱ(n=13)andⅢ(n=6).Nail removal(27.3%,6/22),non-removal(72.7%,16/22)and nail bed repair&suturing(27.3%,6/22)were performed.If direct suturing of nail bed failed,thin tissue of normal nail bed was sliced as a patch for repairing.One recurrent child underwent secondary surgery.During a mean follow-up period of 23.5(6-57)months,there were no such postoperative complications as toe/finger necrosis,paronychondritis or toe/finger armor deformation.The flat appearance of toe/finger armor satisfied children and their parents.At the last follow-up,daily activities and motor functions were not affected.At Month 3 after subnail periosteum resection,1 recurrent child underwent resection of nail bed separation lesion.No recurrence was noted during a postoperative follow-up period of 12 months.Conclusions As a rare benign disease,subungual exostosis in children is frequently located in toe and it may be related to trauma.According to the relationship between lesion location and nail bed,choosing an appropriate incision and nail bed treatment may improve the treatment outcomes.