A systematic review and meta-analysis of randomised controlled trials on surgical treatments for ingrown toenails part I: recurrence and relief of symptoms.

IF 2.5 3区 医学 Q1 ORTHOPEDICS
Victoria Exley, Katherine Jones, Grace O'Carroll, Judith Watson, Michael Backhouse
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引用次数: 2

Abstract

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.

Conclusion: 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.

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对内生趾甲手术治疗的随机对照试验的系统回顾和荟萃分析。第一部分:复发和症状缓解。
背景:趾甲内生是一种常见的指甲病理。当保守治疗无效时,通常采用手术方法。尽管最近的叙述回顾,有必要对治疗内生趾甲的手术方法进行最新和严格的系统回顾。方法:检索五个数据库(MEDLINE, Embase, CINAHL, Web of Science和CENTRAL)和两个注册库(Clinicaltrials.gov和ISRCTN),以评估手术干预对内生趾甲的影响的随机试验,随访至少1个月。两名独立审稿人筛选记录,提取数据,评估偏倚风险和证据的确定性。结果:在确定的3,928条记录中,36(3,756名参与者;系统评价纳入了62.7%(男性)的手术干预措施,meta分析纳入了31项研究。极低质量的证据表明,使用苯酚治疗甲撕脱术与不使用苯酚治疗甲撕脱术相比,可降低复发风险(风险比[RR] 0.13 [95% CI 0.06 ~ 0.27],激光、电灼)(1.61 [0.88 ~ 2.95],p = 0.120;0.58 [0.25 ~ 1.37], p = 0.220),化学vs手术(0.75 [0.46 ~ 1.21],p = 0.230),外科vs外科(0.42[0.21 ~ 0.85]),化学vs化学(0.19 [0.01 ~ 3.80],p = 0.280),外科vs手术+化学(3.68 [0.20 ~ 67.35],p = 0.380),化学vs手术+化学(1.92 [0.06 ~ 62.30],p = 0.710),局部麻醉vs局部麻醉+肾上腺素(1.03 [0.22 ~ 4.86],p = 0.970),化学时间30秒vs 60秒(2.00[0.19 ~ 21.41])或抗生素vs无抗生素(0.54 [0.12 ~ 2.52],p = 0.430)。中央趾甲切除术是唯一能显著缓解症状的手术(p = 0.001),但数据仅在手术后8周可用。结论:尽管发表了大量文献,但研究质量较差,从现有试验中推断出的结论有限。甲基质的酚化似乎可以降低甲消融后复发的风险,在不太确定的情况下,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。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.50
自引率
10.30%
发文量
83
审稿时长
>12 weeks
期刊介绍: Journal of Foot and Ankle Research, the official journal of the Australian Podiatry Association and The College of Podiatry (UK), is an open access journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. Journal of Foot and Ankle Research covers a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care. The journal encourages submissions from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care. The Australian Podiatry Association and the College of Podiatry (UK) have reserve funds to cover the article-processing charge for manuscripts submitted by its members. Society members can email the appropriate contact at Australian Podiatry Association or The College of Podiatry to obtain the corresponding code to enter on submission.
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