对血栓闭塞性脉管炎患者截肢平面的研究  

Study on Amputation Plane of Patients with Thromboangiitis Obliterans

作　　者：唐正君 TANG Zhengjun(Central Hospital Affiliated to Shenyang Medical College 110024)

机构地区：[1]沈阳医学院附属中心医院

出　　处：《航空航天医学杂志》2019年第7期784-786,共3页Journal of Aerospace medicine

摘　　要：目的对血栓闭塞性脉管炎患者截肢平面进行研究。方法对2015年1月-2017年3月采用自体外周血干细胞移植联合置管溶栓术治疗的TAO截肢患者30例(30条患肢)进行分析。结果经统计,23例患者于干细胞移植28天后的下肢疼痛、皮温及冷感评分、踝肱指数(ABI)显著优于移植前(P <0. 05),肢体溃疡及坏死情况好转,现干性坏疽;7例患者未见好转行截肢术,对7例截肢患者拟行截肢平面:其中:2例拟行大腿下段,3例拟行膝关节,2例拟行小腿中上段;术中截肢平面:3例膝关节,2例小腿中上段,2例小腿中段。截肢率23. 33%(7/30),降低截肢平面率71. 42%(5/7)。经对30例患者于术后90天行下肢DSA检查,结果显示全部患者均有不同程度的侧支血管生成,23例保肢患者无坏死范围扩大,且均形成干性坏疽;7例截肢患者截肢平面愈合。经对30例患者进行为期5-19个月(平均12. 1个月)的随访,病情均平稳;但有2例保肢患者因于移植180天后患肢出现较重的疼痛及溃疡坏死,行二次自体外周血干细胞移植术,术后90天患肢症状明显好转。结论对TAO患者行自体外周血干细胞移植与置管溶栓术联合治疗可有效促进新生侧支血管的形成,同时也可有效降低降低截肢率。Objective To study the amputation plane of patients with thromboangiitis obliterans. Methods 30 patients( 30 limbs) with TAO amputation treated by autologous peripheral blood stem cell transplantation combined with catheter thrombolysis from January 2015 to March 2017 were retrospectively analyzed. Results After 28 days of stem cell transplantation,the lower limb pain,skin temperature and cold sensation score,ankle-brachial index( ABI) of 23 patients were significantly better than those before transplantation( P < 0. 05),limb ulcer and necrosis were improved,and dry gangrene was present;7 patients did not improve and amputation was planned for 7 amputated patients. Among them,2 were planned for lower thigh,3 for knee joint and 2 for knee joint. Plane of amputation: 3 knees,2 upper and middle legs and 2 middle legs. The amputation rate was 23. 33%( 7/30) and the amputation plane rate was 71. 42%( 5/7). DSA examination of lower limbs was performed in 30 patients 90 days after operation. The results showed that all patients had collateral angiogenesis in varying degrees,23limb salvage patients had no necrosis and formed dry gangrene,and 7 amputation patients had flat healing of amputation.Thirty patients were followed up for 5-19 months( average 12. 1 months),and the condition was stable. However,two limb salvage patients underwent secondary autologous peripheral blood stem cell transplantation because of severe pain and ulceration necrosis of affected limbs 180 days after transplantation. The symptoms of affected limbs improved significantly 90 days after transplantation. Conclusions The combination of autologous peripheral blood stem cell transplantation and catheter thrombolysis for TAO patients can effectively promote the formation of new collateral vessels and reduce the amputation rate.

关 键 词：外周血干细胞 自体移植 血栓闭塞性脉管炎 缺血 截肢 

分 类 号：R687.5[医药卫生—骨科学]