脊髓电刺激术治疗不可手术的慢性严重肢体缺血1例  

Spinal cord stimulation for non-reconstructable chronic ritical limb ischemiae:a case report

作　　者：李伟浩[1] 张学民[1] 贺致宾 张小明[1] 蒋京军[1] 张韬[1] 李伟[1] 李清乐[1] LI Wei-hao;ZHANG Xue-min;HE Zhi-bin;ZHANG Xiao-ming;JIANG Jing-jun;ZHANG Tao;LI Wei;LI Qing-le(Department of Vascular Surgery,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院血管外科,北京100044

出　　处：《北京大学学报（医学版）》2019年第2期362-364,共3页Journal of Peking University:Health Sciences

摘　　要：肢体动脉闭塞导致的静息痛、肢体溃疡、坏疽等慢性严重肢体缺血(critical limb ischemia, CLI)症状是威胁人类肢体健康、导致截肢的重要原因。周围动脉疾病年发病率为2.35%,年患病率达10.69%,其中每年有1%~3%的患者会进展为CLI,造成极大的社会负担[1]。虽然以球囊扩张支架成形为代表的微创血管腔内治疗技术在近20年获得了极大的成功,但仍有一部分患者因为疾病病变的复杂性,以及全身合并症的制约,而无法接受开放或腔内手术治疗[2-3],不得不饱受疼痛的折磨,最终选择截肢或因并发症死亡[4]。Peripheral arterial disease is one part of systematic atherosclerosis, becoming a heavy burden of human health. Patients in end stage of peripheral arterial disease manifest critical limb ischemia with severe rest pain and refractory ulcer. Surgical revascularization is the optimal option for patients with critical limb ischemia to avoid major amputation and improve quality of life. However, some of them contraindicate surgical revascularizations owing to coexisting morbidities. Spinal cord stimulation is reported to be effective and minimally invasive in pain relief and limb salvage for patients with limb ischemia. Here, we reported one case with chronic critical limb ischemia and gangrene of foot who underwent spinal cord stimulation, which was, as we knew, the first case in China. He was diagnosed with Burger disease and accompanied with history of stroke, chronic obstructive pulmonary disease and Castleman’s disease. It showed totally occlusive lesions of external iliac and femoropopliteal artery and no outflows below the knee in the computed tomography angiography. Given the complexity of lesions and weakness of the patient, spinal cord stimulation was indicated for control of rest pain and limb salvage. As specified, we implanted the temporary neurostimulator as the first step. After 2 weeks from temporary neurostimulator implantation, the patient achieved significant relief in intensity of pain, and acquired 20% improvement of transcutaneous oxygen pressure. The satisfactory results indicated probable effectiveness of spinal cord stimulation, thus we performed the permanent neurostimulator implantation 1 month later. During 2 months of follow-up, the patients stabilized at Fountain Ⅲ with pain relief with one kind of nonsteroidal anti-inflammatory drug. In our case, we confirmed the significant validity of spinal cord stimulation for pain control and consequent improvement of quality of life in non-reconstructable chronic critical limb ischemia . Furthermore, we reviewed that a number of published stud

关 键 词：重症肢体缺血 脊髓电刺激 外周动脉疾病 

分 类 号：R654.4[医药卫生—外科学]