股-股动脉旁路移植联合胫骨横向骨搬移术治疗下肢动脉硬化闭塞症或合并糖尿病足  

Application of femoral-femoral artery bypass grafting combined with transverse tibial bone transporting for lower extremity arteriosclerosis obliterans or combined with diabetic foot

作　　者：王斌[1] 刘伟[1] 霍永新[1] 宫中平[1] 王伟[1] 郝睿峥[1] 方钧 张荐[1] 蒋文平[1] WANG Bin;LIU Wei;HUOYongxin;GONG Zhongping;WANG Wei;HAO Ruizheng;FANG Jun;ZHANG Jian;JIANG Wenping(Department of Hand Surgery,Repair and Reconstruction Surgery,Lower Limb Vascular Disease,the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University),Tangshan Hebei,063000,P.R.China)

机构地区：[1]唐山市第二医院(华北理工大学附属骨科医院)手外科修复重建外科下肢血管病科,河北唐山063000

出　　处：《中国修复重建外科杂志》2018年第12期1576-1580,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨股-股动脉旁路移植联合胫骨横向骨搬移术治疗下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)或合并糖尿病足的临床疗效。方法 2014年3月—2016年6月,采用股-股动脉旁路移植联合胫骨横向骨搬移术治疗9例下肢ASO或合并糖尿病足男性患者;年龄63～82岁,平均74.2岁。ASO病程1.5～22.0个月,平均10.5个月。均为单侧髂动脉严重闭塞,左侧5例、右侧4例;合并股浅和/或膝下动脉病变7例。单纯ASO 7例,合并糖尿病足2例(Wagner分级均为4级);ASO Fontaine分期均为Ⅳ期。术前均有静息痛,踝肱指数为0.24±0.12。股-股动脉旁路移植术中7例采用人工血管、2例采用自体大隐静脉。术后第8天开始向外骨搬移,每天延长1 mm,每6小时1次,2～3周后再向内搬移,整个疗程共10～14周。结果 1例胫骨横向骨搬移切口部分皮肤坏死,经换药后愈合,针道口无明显并发症;其余患者无切口并发症。胫骨横向骨搬移后足部创面肉芽组织生长快,2～3周后创面明显缩小。9例患者均获随访,随访时间12～32个月,平均19个月。术后2个月踝肱指数为0.67±0.09,较术前显著提高,差异有统计学意义(t=17.510,P=0.032)。患足溃疡创面均愈合,愈合时间6.7～9.4周,平均7.7周。随访期间彩超或CT检查示移植血管通畅。术后12～14周去除外固定延长器。1例术后14个月因突发心肌梗死死亡,无切口淋巴漏。术后1年股-股动脉旁路通畅率达100%。术后4～6个月胫骨横向骨搬移段均与胫骨愈合。末次随访时显效率达100%。结论股-股动脉旁路移植联合胫骨横向骨搬移术是治疗下肢ASO或合并糖尿病足的有效方法。Objective To discuss the effectiveness of femoral-femoral artery bypass grafting combined withtransverse tibial bone transporting in treatment of lower extremity arteriosclerosis obliterans (ASO) or combined withdiabetic foot. Methods Between March 2014 and June 2016, 9 patients with lower extremity ASO or combined withdiabetic feet were treated with femoral-femoral artery bypass grafting and transverse tibial bone transporting. All patientswere male, aged from 63 to 82 years with an average of 74.2 years. The disease duration of ASO was 1.5-22.0 months(mean, 10.5 months). All cases were severe unilateral iliac arterial occlusion, including 5 cases of the left side and 4 cases ofthe right side. There were 7 cases with superficial femoral and/or infrapopliteal artery disease. There were 7 cases of ASOand 2 cases of ASO combined with diabetic foot (Wagner grade 4); all the ASO were grade Ⅳ according to Fontainecriteria. All patients had rest pain before operation, and the ankle brachial index was 0.24±0.12. In femoral-femoral arterybypass grafting operations, artificial blood vessels were used in 7 cases and autologous saphenous vein were used in theother 2 cases. The tibial bone transverse transporting began on the 8th day after operation by 1 mm per day and once per6 hours; after transported for 2-3 weeks, it was moved back. The whole course of treatment was 10-14 weeks. Results Theincision of tibial bone transverse transporting was necrotic in 1 case, and healed after dressing change. There was noobvious complication at the orifice of the needle. The other patients had no incision complication. The granulation tissueof foot wound was growing quickly after tibial bone transverse transporting, and the wound was reduced after 2-3 weeks.All the 9 patients were followed up 12-32 months (mean, 19 months). The ankle brachial index was 0.67±0.09 at 2 monthspostoperatively, which was significantly higher than that before operation (t=17.510, P=0.032). All the feet ulcer woundshealed and the healing time was 6.7-9.4 w

关 键 词：动脉硬化闭塞症 股动脉 旁路 胫骨横向骨搬移术 

分 类 号：R654.4[医药卫生—外科学]