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陥入爪とTube sprint
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陥入爪とTube sprint
1.
兵庫民医連家庭医療学センター アドバイザー 守屋章成 2011年6月20日
2.
なぜ陥入爪が生じるのか 陥入爪と巻き爪の違い
外科治療と保存的治療 保存的治療としてのtube sprint
3.
原因は4箇所にある(複合あり) 1. 爪そのもの(爪の形状)
巻き爪 2. 爪と軟部組織の形状の相関 爪を巻き込むような軟部組織の発達 3. 爪の切り方 ※経験的に寄与度が最も高い 4. 外力(不適切な外力) 不適切な靴 強い踏み込み動作を繰り返す運動
4.
よく混同しがち 陥入爪 ◦
先の4つの原因が元で爪が軟部組織に食い込んで肉芽腫性 炎症と疼痛を生ずる状態 巻き爪 ◦ 爪が生理的彎曲以上の過度の彎曲・変形を呈している状態 ◦ 陥入爪を生じることがしばしば
5.
外科治療 ◦ 全抜爪 ◦
部分抜爪 古典的術式 フェノール法 ◦ でも外科治療は(*´・ω・)(・ω・`*)ネー 保存的治療 ◦ Tube sprint ◦ 条件が揃えば爪矯正 マチワイヤ,VHO
6.
経験的にはかなり有効な保存的治療 治療直後から疼痛軽減が得られる
用意するもの ◦ 硝酸銀+生理食塩水 ◦ 20G翼状針(のチューブ) ◦ 4-0~5-0ナイロン糸 ◦ 25G注射針(12mm?) 滅菌操作不要,抗菌薬不要
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しかも肝心のthornは軟部組織に 埋もれて視認不可能
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どうする?
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硝酸銀1-2mmの欠片を肉芽に置く ◦ 摂子で把持したまま押し当てる ◦
普通肉芽は炎症性の滲出液を伴っているのですぐに化学反 応(腐食)を起こす 30秒ぐらいで肉芽が腐食して退縮する ◦ 真っ黒になる ◦ 退縮が不十分なら繰り返す ある程度退縮したら生理食塩水で中和して反応を止 める ◦ AgNO3 + 2NaCl → Na2NO3 + AgCl2
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挿入の実際はブラインド操作 抵抗を感じたらそこがthorn
Thornをtube端が超えるときが正念場 ◦ 最も痛い瞬間だが,超えれば楽になる 超えたらさらに5mmぐらい深く挿入して糸固定する 爪の切り過ぎでどうしても糸固定するスペースがなけ れば生体用アロンアルファやペディキュア毎日塗布で ◦ 脱落しやすいので反復処置する
30.
脱落しない限りはそのまま数週間放置 やがて爪が伸長して,tubeに覆われたthorn部分が 軟部組織外へ顔を出す
そのthornを患者自身に見せる! その上で適切な爪切り指導 →Facebookの守屋のアルバムへ
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