中国修复重建外科杂志

中国修复重建外科杂志

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

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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 with transverse tibial bone transporting in treatment of lower extremity arteriosclerosis obliterans (ASO) or combined with diabetic foot. Methods Between March 2014 and June 2016, 9 patients with lower extremity ASO or combined with diabetic feet were treated with femoral-femoral artery bypass grafting and transverse tibial bone transporting. All patients were 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 of the right side. There were 7 cases with superficial femoral and/or infrapopliteal artery disease. There were 7 cases of ASO and 2 cases of ASO combined with diabetic foot (Wagner grade 4); all the ASO were grade Ⅳ according to Fontaine criteria. All patients had rest pain before operation, and the ankle brachial index was 0.24±0.12. In femoral-femoral artery bypass grafting operations, artificial blood vessels were used in 7 cases and autologous saphenous vein were used in the other 2 cases. The tibial bone transverse transporting began on the 8th day after operation by 1 mm per day and once per 6 hours; after transported for 2-3 weeks, it was moved back. The whole course of treatment was 10-14 weeks. Results The incision of tibial bone transverse transporting was necrotic in 1 case, and healed after dressing change. There was no obvious complication at the orifice of the needle. The other patients had no incision complication. The granulation tissue of 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 months postoperatively, which was significantly higher than that before operation (t=17.510, P=0.032). All the feet ulcer wounds healed and the healing time was 6.7-9.4 weeks (mean, 7.7 weeks). During follow-up, color Doppler ultrasound or CT examination revealed grafted blood vessel patency. The external fixator was removed at 12-14 weeks after operation. One case died of sudden myocardial infarction at 14 months after operation, and there was no lymphatic leakage. The patency rate of femoral-femoral bypass was 100% at 1 year after operation. The tibial transverse bone grafting healed with tibia at 4-6 months after operation. At last follow-up, the effective rate was 100%. Conclusion Femoral-femoral artery bypass grafting combined with transverse tibial bone transporting is an effective method in the treatment of lower extremity ASO or combined with diabetic foot.

关键词: 动脉硬化闭塞症; 股动脉; 旁路; 胫骨横向骨搬移术

Key words: Arteriosclerosis obliterans; femoral artery; bypass; transverse tibial bone transporting

引用本文: 王斌, 刘伟, 霍永新, 宫中平, 王伟, 郝睿峥, 方钧, 张荐, 蒋文平. 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. 中国修复重建外科杂志, 2018, 32(12): 1576-1580. doi: 10.7507/1002-1892.201806124 复制

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