胫骨横向骨搬移技术的血管条件及重建的探讨  

Study on vascular selection and reconstruction in tibial transverse transport

作　　者：王斌[1] 刘伟[1] 宫中平[1] 王伟[1] 郝睿峥[1] 涂振兴 杨焕友[1] 霍永鑫[1] 卢爱东[2] WANG Bin;LIU Wei;GONG Zhongping;WANG Wei;HAO Ruizheng;TU Zhenxing;YANG Huanyou;HUO Yongxin;LU Aidong(Department of Hand Surgery,Repair and Reconstruction Surgery,and Lower Limb Vascular Diseases,the Second Hospital of Tangshan,Tangshan Hebei,063000,P.R.China;Department of Ophthalmology,Kailuan General Hospital,Tangshan Hebei,063000,P.R.China)

机构地区：[1]唐山市第二医院手外科、修复重建外科、下肢血管病科,河北唐山063000 [2]开滦总医院眼科,河北唐山063000

出　　处：《中国修复重建外科杂志》2020年第12期1579-1584,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的从血管外科视角探讨胫骨横向骨搬移技术治疗下肢慢性缺血性疾病时,需满足的血管条件及血管重建的必要性。方法回顾分析2014年2月—2019年7月采用胫骨横向骨搬移技术治疗的59例下肢慢性缺血性疾病患者临床资料。其中,糖尿病足(diabetic foot,DF)患者41例,Wagner 3~4级、Texas 2~3级、B^D期病变;病程0.7~2.4年,平均1.5年;合并下肢动脉硬化闭塞症(arteriosclerosis obliteran,ASO)5例。ASO患者14例,病程1.5~23.4个月,平均10.8个月;FontaineⅣ期、RutherfordⅢ~Ⅳ期。下肢血栓闭塞性脉管炎(thromboangiitis obliteran,TAO)患者4例,病程2.1~18.2个月,平均12.3个月;临床分期均为三期。其中,18例术前胫前或胫后动脉踝肱指数(ankle brachial index,ABI)<0.6,或者影像学检查膝下胫前动脉的3条分支均未通达踝部者,行血管重建开通上游血管(DF合并ASO 5例、ASO 12例、TAO 1例)。术后通过溃疡创面愈合情况、皮温、疼痛视觉模拟评分(VAS)、ABI、CT血管造影(CT angiography,CTA)检查等进行疗效评估。结果DF患者获随访8~16个月,平均12.2个月;溃疡创面均愈合,愈合时间5.1~9.2周,平均6.8周;5例行血管重建者术后CTA观察膝下胫前动脉分支血管再通;胫骨截骨均愈合,愈合时间5~14周,平均8.3周。ASO患者获随访13~25个月,平均16.8个月;溃疡创面愈合时间6.2~9.7周,平均7.4周;其中12例血管重建者术后CTA检查显示膝下胫前动脉分支再通;胫骨截骨均愈合,愈合时间4.5~14.4周,平均10.2周。TAO患者获随访12~23个月,平均12.3个月;治疗无效最终行截趾/肢。根据患者是否血管重建分组分析,联合血管重建组术后6个月ABI、VAS评分、皮温均较术前明显改善(P<0.05);单纯骨搬移组术后6个月ABI与术前比较差异无统计学意义(t=0.252,P=0.840),但皮温及VAS评分较术前明显改善(P<0.05)。结论胫前和/或胫后动脉ABI≥0.6、影像学检查显示膝下胫前动脉3条分支中至少1条通达踝部Objective To explore the vascular conditions and the necessity of vascular reconstruction in the treatment of chronic ischemic diseases of lower extremities with tibial transverse transport(TTT)from the perspective of vascular surgery.Methods A clinical data of 59 patients with chronic ischemic disease of lower extremities treated by TTT between February 2014 and July 2019 were analyzed retrospectively.Among them,there were 41 patients with diabetic foot(DF),including Wagner grade 3-4,Texas grade 2-3,and stage B-D lesions;the disease duration ranged from 0.7 to 2.4 years,with an average of 1.5 years,and 5 cases complicated with arteriosclerosis obliteran(ASO).There were 14 patients with ASO(Fontaine stageⅣand Rutherford stageⅢ-Ⅳ)with an average disease duration of 10.8 months(range,1.5-23.4 months).There were 4 patients with thromboangiitis obliteran(TAO)with an average disease duration of 12.3 months(range,2.1-18.2 months),and the clinical stages were all in the third stage.In 18 patients that ankle brachial index(ABI)of anterior or posterior tibial artery was less than 0.6 before operation,or the blood flow of the three branches of inferior anterior tibial artery did not reach the ankle by imaging examination,vascular reconstruction was performed before TTT(5 cases of DF combined with ASO,12 of ASO,1 of TAO).After operation,the effectiveness was evaluated by ulcer wound healing,skin temperature,pain visual analogue scale(VAS)score,ABI,and CT angiography(CTA)examination.Results The patients with DF were followed up 8-16 months(mean,12.2 months);the ulcer wounds healed with a healing time of 5.1-9.2 weeks(mean,6.8 weeks);CTA examination showed that the branches of inferior anterior tibial artery were opened in 5 patients after revascularization;and the tibial osteotomy healed for 5-14 weeks(mean,8.3 weeks).The patients with ASO were followed up 13-25 months(mean,16.8 months);the ulcer wounds healed with a healing time of 6.2-9.7 weeks(mean,7.4 weeks).CTA examination showed that the branches of inferior ante

关 键 词：胫骨横向骨搬移技术 下肢缺血性疾病 适应证 血管重建 

分 类 号：R687.3[医药卫生—骨科学]