保留搬移骨块血运的微创截骨在胫骨横向骨搬移中的应用  

Application of minimally invasive osteotomy with preservation of blood supply to transversely transported bone segment in tibial transverse bone transport

作　　者：王斌[1] 高贵族 涂振兴 杨焕友[1] 郝睿峥[1] 部文茜[1] WANG Bin;GAO Guizu;TU Zhenxing;YANG Huanyou;HAO Ruizheng;BU Wenqian(Department of Hand Surgery,the Second Hospital of Tangshan,Tangshan Hebei,063000,P.R.China;Department of Orthopedics,North China University of Science and Technology Affiliated Hospital,Tangshan Hebei,063000,P.R.China;Department of Orthopedics,the 910th Hospital of Joint Logistic Support Force of Chinese PLA,Quanzhou Fujian,362000,P.R.China)

机构地区：[1]唐山市第二医院手外科,河北唐山063000 [2]华北理工大学附属医院骨科,河北唐山063000 [3]中国人民解放军联勤保障部队第910医院骨科,福建泉州362000

出　　处：《中国修复重建外科杂志》2025年第3期320-325,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：河北省自然科学基金项目(H2021105020)。

摘　　要：目的探讨保留搬移骨块血运的微创截骨在胫骨横向骨搬移治疗下肢慢性缺血性疾病中应用的效果。方法回顾分析2016年6月—2023年12月收治且符合选择标准的12例下肢慢性缺血性疾病患者临床资料。男7例,女5例;年龄26~87岁,平均61.2岁。其中糖尿病足(diabetic foot,DF)患者7例[合并下肢动脉硬化闭塞症(arteriosclerosis obliterans,ASO)2例],DF病程1.7~23.0个月,平均9.6个月;溃疡范围3.2 cm×2.4 cm~10.0 cm×6.6 cm。ASO患者3例,病程1.7~23.0个月,平均10.4个月;溃疡或截趾创面范围2.2 cm×2.1 cm~12.0 cm×7.7 cm。下肢血栓闭塞性脉管炎(thromboangiitis obliterans,TAO)患者2例,病程分别为7、12个月。术前患者足部皮温(27.63±0.34)℃,疼痛视觉模拟评分(VAS)为(8.5±0.7)分。采用保留搬移骨块血运的微创截骨胫骨横向骨搬移治疗。术后观察并发症及足部溃疡愈合情况;通过手术前后足部皮温、VAS评分及CT血管造影(CT angiography,CTA)检测评估胫骨横向骨搬移效果。结果除1例DF合并ASO患者失访外,余11例均获随访,随访时间10~29个月,平均20.5个月。1例DF患者因外伤致胫骨搬移处移位骨折,石膏固定后骨愈合;1例DF患者骨搬移区皮肤少量色素沉着,但复查血液循环良好;所有患者骨搬移区均未出现钉道感染、皮肤坏死、骨髓炎等并发症。术后2~3周患者足部皮温(34.21±0.65)℃、VAS评分(0.3±0.1)分,均较术前显著改善(t=−31.578,P<0.001;t=49.000,P<0.001)。2例TAO患者术后7~10 d后持续性难忍性疼痛复发,溃疡及坏死区未见缩小;其中1例行小趾截趾,1例小腿中段截肢。其余患者术后足部溃疡均愈合,愈合时间5.1~9.2周,平均6.8周。CTA示无新发血管闭塞或栓塞。术后4个月复查X线片示胫骨骨搬移骨块复位、愈合良好。结论保留搬移骨块血运的微创截骨应用于胫骨横向骨搬移治疗下肢慢性缺血性疾病,可有效减少软组织剥离范围,降低术区软组织损伤,�Objective To investigate the efficacy of minimally invasive osteotomy with preservation of blood supply to the transversely transported bone segment in the treatment of chronic ischemic lower limb diseases using tibial transverse bone transport.Methods A retrospective analysis was conducted on the clinical data of 12 patients with chronic ischemic lower limb diseases who met the selection criteria and were treated between June 2016 and December 2023.The cohort included 7 males and 5 females,aged 26-87 years(mean,61.2 years).Among them,7 patients had diabetic foot(DF),including 2 cases complicated by arteriosclerosis obliterans(ASO),with a DF duration ranging from 1.7 to 23.0 months(mean,9.6 months)and ulcer sizes ranging from 3.2 cm×2.4 cm to 10.0 cm×6.6 cm.Three patients had ASO with a disease duration of 1.7-23.0 months(mean,10.4 months)and ulcer or post-amputation wound sizes ranging from 2.2 cm×2.1 cm to 12.0 cm×7.7 cm.Additionally,2 patients with thromboangiitis obliterans(TAO)had a disease duration of 7 and 12 months,respectively.Preoperatively,the mean foot skin temperature was(27.63±0.34)℃,and the visual analogue scale(VAS)score was 8.5±0.7.All patients underwent tibial transverse bone transport using minimally invasive osteotomy while preserving the blood supply to the transported bone segment.Postoperative complications and foot ulcer healing were observed.The effectiveness of tibial transverse bone transport was evaluated by comparing preoperative and postoperative foot skin temperature,VAS scores,as well as through CT angiography(CTA).Results One DF patient with ASO was lost to follow-up,while the remaining 11 patients were followed up 10-29 months(mean,20.5 months).One DF patient had a displaced fracture at the site of tibial transport due to trauma,which healed after plaster immobilization;1 DF patient had a small amount of pigmentation in the skin of the donor site,but the blood circulation was good;no complication such as pin tract infection,skin necrosis,or osteomyelitis occurred in the d

关 键 词：胫骨横向骨搬移 微创截骨 下肢慢性缺血性疾病 血管重建 

分 类 号：R68[医药卫生—骨科学]