背景:内胎趾甲是一种常见的指甲病理学。当保守治疗无效时,经常使用手术方法。尽管最近有叙述评论,有必要对治疗嵌甲的手术方法进行最新和严格的系统评价.
方法:五个数据库(MEDLINE,Embase,CINAHL,WebofScienceandCENTRAL)和两个登记册(Clinicaltrials.gov和ISRCTN)在2022年1月进行了随机试验,以评估手术干预对向内生长的脚趾甲的影响,并进行了至少1个月的随访。两名独立的审稿人筛选了记录,提取的数据,评估证据的偏倚风险和确定性。
结果:在确定的3,928条记录中,36(3,756名参与者;62.7%的男性)外科手术干预被纳入系统评价,31项研究被纳入荟萃分析。有非常低质量的证据表明,使用苯酚的指甲撕脱与不使用苯酚的指甲撕脱可降低复发风险(风险比[RR]0.13[95%CI0.06至0.27],p<0.001)。在化学或手术与保守治疗之间没有观察到有利的效果(0.55[0.19to1.61],p=0.280;0.72[0.33至1.56],p=0.410),化学或外科与其他(例如,CO2激光,电灼)(1.61[0.88至2.95],p=0.120;0.58[0.25至1.37],p=0.220),化学与外科(0.75[0.46至1.21],p=0.230),手术与手术(0.42[0.21至0.85]),化学与化学(0.19[0.01至3.80],p=0.280),外科与外科+化学(3.68[0.20至67.35],p=0.380),化学与外科化学(1.92[0.06至62.30],p=0.710),局部麻醉剂与局部麻醉剂+肾上腺素(1.03[0.22to4.86],p=0.970),化学时间30秒与60秒(2.00[0.19至21.41])或抗生素与无抗生素(0.54[0.12至2.52],p=0.430)。中央趾甲切除术是唯一显着缓解症状的方法(p=0.001),但数据仅在手术后8周内可用。
结论:尽管出版物数量众多,研究质量较差,可从现有试验推断的结论有限.指甲基质的酚化似乎可以降低指甲消融后复发的风险。并且不太确定1分钟似乎是应用的最佳时间。尽管这是一个广泛执行的程序,但仍然缺乏高质量的证据来指导实践。
BACKGROUND: Ingrown toenails are a common nail pathology. When conservative treatments are ineffective, a surgical approach is often utilised. Despite recent narrative reviews, there is a need for an up-to-date and rigorous systematic review of surgical methods for treating ingrown toenails.
METHODS: Five databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails with a follow-up of at least 1 month. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence.
RESULTS: Of 3,928 records identified, 36 (3,756 participants; 62.7% males) surgical interventions were included in the systematic review and 31 studies in the meta-analysis. There was very low quality evidence that using phenol with nail avulsion vs nail avulsion without phenol reduces the risk of recurrence (risk ratio [RR] 0.13 [95% CI 0.06 to 0.27], p < 0.001). No favourable effect was observed between chemical or surgical vs conservative management (0.55 [0.19 to 1.61], p = 0.280; 0.72 [0.33 to 1.56], p = 0.410), chemical or surgical vs other (e.g., CO2 laser, electrocautery) (1.61 [0.88 to 2.95], p = 0.120; 0.58 [0.25 to 1.37], p = 0.220), chemical vs surgical (0.75 [0.46 to 1.21], p = 0.230), surgical vs surgical (0.42 [0.21 to 0.85]), chemical vs chemical (0.19 [0.01 to 3.80], p = 0.280), surgical vs surgical + chemical (3.68 [0.20 to 67.35], p = 0.380), chemical vs surgical + chemical (1.92 [0.06 to 62.30], p = 0.710), local anaesthetic vs local anaesthetic + adrenaline (1.03 [0.22 to 4.86], p = 0.970), chemical timings 30 s vs 60 s (2.00 [0.19 to 21.41]) or antibiotics vs no antibiotics (0.54 [0.12 to 2.52], p = 0.430). Central toenail resection was the only procedure to significantly relieve symptoms (p = 0.001) but data were only available up to 8 weeks post-surgery.
CONCLUSIONS: Despite the high number of publications, the quality of research was poor and the conclusions that can be inferred from existing trials is limited. Phenolisation of the nail matrix appears to reduce the risk of recurrence following nail ablation, and with less certainty 1 min appears to be the optimum time for application. Despite this being a widely performed procedure there remains a lack of good quality evidence to guide practice.