ﻣﻘﺎﻳﺴﺔ دو روش ﻣﺎﺗﺮﻳﺴﻜﺘﻮﻣﻲ در درﻣﺎن رﺷﺪ ﻧﺎﻣﻨﺎﺳﺐ ﻧﺎﺧﻦ ﺷﺴﺖ ﭘﺎ

Comparison of Two Methods of Matrisectomy in Treatment of Ingrowing Toenail

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: Ingrown Toenail ﺑﻪ ﻋﻨﻮﺍﻥ ﺭﺷﺪ ﻏﻴﺮﻃﺒﻴﻌﻲ ﻧﺎﺧﻦ ﺑﻪ ﭼﻴﻦ ﻫﺎﻱ ﻃﺮﻓﻲ ﺩﺭﺑﺮﮔﻴﺮﻧﺪﻩ ﻧﺎﺧﻦ ﺗﻌﺮﻳﻒ ﻣﻲ ﺷﻮﺩ. ﺩﺭﻣﺎﻥ ﻣﺮﺣﻠﻪ ﺳﻮﻡ ﺍﻳﻦ ﺑﻴﻤﺎﺭﻱ، ﺟﺮﺍﺣﻲ ﺍﺳﺖ. ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﻣﻨﻈﻮﺭ ﻣﻘﺎﻳﺴﻪ ﻧﺘﺎﻳﺞ ﺩﺭﻣﺎﻧﻲ ﺩﻭ ﺭﻭﺵ ﺑﺮﺩﺍﺷﺖ ﻣﺎﺗﺮﻳﮑﺲ ﻧﺎﺧﻦ ﺑﺎ ﺟﺮﺍﺣﻲ ﻭ ﺳﻮﺯﺍﻧﺪﻥ ﺁﻥ ﺑﺎ ﻓﻨﻞ ﺩﺭ ﺩﺭﻣﺎﻥ ﺭﺷﺪ ﻧﺎ ﻣﻨﺎﺳﺐ ﻧﺎﺧﻦ ﭘﺎ ﻃﺮﺍﺣﻲ ﻭ ﺍﺟﺮﺍ ﺷﺪﻩ ﺍﺳﺖ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﻳـﻦ ﻣﻄـﺎﻟﻌـﻪ ﺍﺯ ﻧـﻮﻉ ﮐـﺎﺭﺁﺯﻣـﺎﻳﻲ ﺑﺎﻟﻴﻨــﻲ ﻭ ﺗﺤﻠﻴﻠـﻲ ﻣﻲ ﺑـﺎﺷــﺪ. ﺟﺎﻣﻌـﻪ ﻣـﻮﺭﺩ ﺑــﺮﺭﺳﻲ، ﺑﻴﻤــﺎﺭﺍﻥ ﻣﺒﺘــﻼ ﺑﻪ Ingrown Toenail ﺩﺭ Stage IIIﻣﻲ ﺑﺎﺷﺪ ﮐﻪ ﺍﺯ ﺗﻴﺮ ﻣﺎﻩ 1376 ﺗﺎ ﻣﻬـﺮ ﻣﺎﻩ 1382 ﺟﻬﺖ ﺩﺭﻣـﺎﻥ ﺑﻪ ﺩﺭﻣﺎﻧﮕﺎﻩ ﻫﺎﻱ ﺟﺮﺍﺣﻲ ﺑﻴﻤـﺎﺭﺳﺘﺎﻥ ﺍﻓﺸﺎﺭ ﻭ ﺷﻬﻴﺪ ﺭﻫﻨﻤﻮﻥ ﻳﺰﺩ ﻣﺮﺍﺟﻌﻪ ﮐﺮﺩﻩ ﺍﻧﺪ. ﭘﺲ ﺍﺯ ﺣﺬﻑ ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺑﻴﻤـﺎﺭﻱ ﺯﻣﻴﻨـﻪ ﺍﻱ، ﺩﻳﺎﺑـﺖ، ﻧﻘـﺺ ﺍﻳﻤﻨـﻲ ﻭ ﻳﺎ ﺗﺤﺖ ﺭﺍﺩﻳـﻮﺗﺮﺍﭘﻲ ﻳﺎ ﺷﻴﻤﻲ ﺩﺭﻣﺎﻧﻲ ﺑﻮﺩﻧﺪ، ﻧﻤﻮﻧﻪ ﮔﻴﺮﻱ ﺑﻪ ﺭﻭﺵ ﺳﺮﺷﻤـﺎﺭﻱ ﺍﻧﺠـﺎﻡ ﺷﺪ ﻭ ﻧﻤـﻮﻧﻪ ﻫﺎ ﺑﻪ ﺭﻭﺵ ﻧﻤـﻮﻧﻪ ﮔﻴـﺮﻱ ﺗﺼﺎﺩﻓﻲ ﺳﻴﺴﺘﻤـﺎﺗﻴﮏ ﺑﻪ ﺩﻭ ﮔـﺮﻭﻩ 130 ﻧﻔﺮﻩ ﺗﻘﺴﻴﻢ ﺷﺪﻧﺪ. ﺩﻭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘﻮﻣﻲ ﺷﻴﻤﻴﺎﻳﻲ ﺑﺎ ﻓﻨﻞ ﻭ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺟﺮﺍﺣﻲ ﺑﺎ ﻫـﻢ ﻣﻘﺎﻳﺴـﻪ ﻭ ﺑﻴﻤـﺎﺭﺍﻥ ﺗﺎ 2 ﺳﺎﻝ ﭘﻴﮕﻴﺮﻱ ﺷﺪﻧﺪ ﺗﺎ ﺗﻌﺪﺍﺩ 260 ﻧﻤﻮﻧﻪ ﺗﮑﻤﻴﻞ ﺷﺪ. ﺍﻃﻼﻋﺎﺕ ﺍﺯ ﻃﺮﻳﻖ ﭘﺮﺳﺸﻨﺎﻣـﻪ ﺟﻤﻊ ﺁﻭﺭﻱ ﻭ ﺳﭙـﺲ ﺑﺎ ﺁﺯﻣـﻮﻥ ﻫﺎﻱ ﺁﻣﺎﺭﻱ ﮐﺎﻱ ﺍﺳﮑﻮﺍﺭ ﻭ ﺁﻧﺎﻟﻴـﺰ ﻭﺍﺭﻳﺎﻧﺲ ﻧﺘﺎﻳﺞ ﺗﺠﺰﻳﻪ ﻭ ﺗﺤﻠﻴﻞ ﮔﺮﺩﻳﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴـﺰﺍﻥ ﺑﺮﻭﺯ ﻋﻔـﻮﻧﺖ ﺩﺭ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺟﺮﺍﺣﻲ ﮐﻤﺘﺮ ﺍﺯ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺷﻴﻤﻴﺎﻳﻲ ﻭ ﺩﺭ ﻣـﺮﺩﺍﻥ ﺑﻴـﺶ ﺍﺯ ﺯﻧﺎﻥ ﺑﻮﺩﻩ ﮐﻪ ﺍﺯ ﻧﻈﺮ ﺁﻣﺎﺭﻱ ﻣﻌﻨﻲ ﺩﺍﺭ ﺍﺳﺖ ﻭ ﺑﺎ ﺷﻐـﻞ ﻭ ﺳﻦ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺭﺗﺒـﺎﻁ ﺩﺍﺭﺩ. ﻣﻴـﺰﺍﻥ ﺑﺮﻭﺯ ﻋـﻮﺩ ﺩﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺟـﺮﺍﺣﻲ 3/98 ﻭ ﺩﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘﻮﻣﻲ ﺷﻴﻤﻴﺎﻳﻲ 11/8 ﻣﻲ ﺑﺎﺷـﺪ ﻭ ﺑﺎ ﺳﻦ ﻭ ﺟﻨﺲ ﺍﺭﺗﺒﺎﻁ ﺩﺍﺭﺩ. ﻃﻮﻝ ﻣـﺪﺕ ﺯﻣﺎﻥ ﻋﻤـﻞ ﺩﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺟﺮﺍﺣﻲ 13/8 ﺩﻗﻴﻘﻪ ﻭ ﺩﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘﻮﻣﻲ ﺷﻴﻤﻴﺎﻳﻲ 8/6 ﺩﻗﻴـﻘﻪ ﻣﻲ ﺑﺎﺷﺪ ﮐﻪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ -P Value ﺑﻪ ﺩﺳﺖ ﺁﻣـﺪﻩ ﻣﻌﻨﻲ ﺩﺍﺭ ﻣﻲ ﺑﺎﺷـﺪ. ﻣﺘﻮﺳﻂ ﻫﺰﻳﻨﻪ ﺩﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘﻮﻣﻲ ﺟﺮﺍﺣﻲ 100/000 ﺭﻳﺎﻝ ﻭ ﺩﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺷﻴﻤﻴﺎﻳﻲ 54000 ﺭﻳﺎﻝ ﻣﻲ ﺑﺎﺷـﺪ ﮐﻪ P-Value ﻣﻌﻨﻲ ﺩﺍﺭ ﻣﻲ ﺑﺎﺷﺪ. ﺩﺭ ﻣﺠﻤـﻮﻉ ﻣﻴـﺰﺍﻥ ﻋـﻮﺩ، ﻋﻔـﻮﻧﺖ ﻭ ﻃـﻮﻝ ﻣـﺪﺕ ﺍﺯ ﮐﺎﺭ ﺍﻓﺘـﺎﺩﮔﻲ ﺩﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺷﻴﻤﻴـﺎﻳﻲ ﺑﻴﺸﺘـﺮ ﺍﺯ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘﻮﻣﻲ ﺟﺮﺍﺣﻲ ﻣﻲ ﺑﺎﺷـﺪ ﻭﻟﻲ ﻃـﻮﻝ ﻣـﺪﺕ ﻋﻤـﻞ ﻭ ﻫـﺰﻳﻨﻪ ﺩﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺷﻴﻤﻴـﺎﻳﻲ ﮐﻤﺘـﺮ ﺍﺯ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘﻮﻣﻲ ﺟﺮﺍﺣﻲ ﻣﻲ ﺑﺎﺷﺪ ﻳﻌﻨﻲ ﺑﺮﺍﻱ ﺑﻴﻤﺎﺭ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺟـﺮﺍﺣﻲ ﺑﻬﺘـﺮ ﺍﺯ ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺷﻴﻤﻴﺎﻳﻲ ﻣﻲ ﺑﺎﺷﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﻪ ﻧﻈﺮ ﻣﻲ ﺭﺳﺪ ﺩﺭ ﻣﺠﻤـﻮﻉ، ﺭﻭﺵ ﻣﺎﺗﺮﻳﺴﮑﺘـﻮﻣﻲ ﺟﺮﺍﺣﻲ ﻣﻨﺎﺳﺐ ﺗﺮ ﺍﺯ ﻣﺎﺗﺮﻳﺴﮑﺘﻮﻣﻲ ﺷﻴﻤﻴﺎﻳﻲ ﻣﻲ ﺑﺎﺷﺪ.

Introduction & Objective: Ingrowing of the nail of the hallux has been described to an abnormality of the shape of the nail; in stage III of diseases surgical treatment indicated. This study evaluated two methods of treatment: (a) a surgical matricectomy and (b) chemical matrisectomy. Materials & Methods: In this randomized clinical trial study, 260 patients were seen in a special general surgery clinic, were assessed for severity and duration of symptoms. 130 patients were treated with chemical matrisectomy and 130 patients were treated with surgical matricectomy those with no history of immunocompremised diseases and diabetes mellitus and with only minor infection were treated by the surgical matricectomy. The nail was nicked and torn down to expose the infected nail fold. The patients were then taught to clean the area, spray it with povidone-iodine dry powder, and pack the nail fold with a twist of cottonwool. Patient; with recurrent or severe ingrowing toenails were treated by chemical matrisectomy. Results: The rate of infection in surgical matricectomy in men was less than woman. The recurrence rate in surgical matricectomy was 3.98% and in chemical matrisectomy was %11.8. The operative time was 13.8 and 8.6 minute in chemical matrisectomy. The operative cost was less in chemical matrisectomy. Conclusions: On the whole surgical matrisectomy is a better procedure than chemical matrisectomy