[1]杨思捷,陈炎,邝晓聪,等.胫骨横向骨搬移术治疗下肢血栓闭塞性脉管炎[J].中医正骨,2020,32(07):58-61.
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胫骨横向骨搬移术治疗下肢血栓闭塞性脉管炎()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年07期
页码:
58-61
栏目:
临床报道
出版日期:
2020-07-20

文章信息/Info

作者:
杨思捷1; 陈炎2; 邝晓聪3; 庄胜1; 何立环2; 镇普祥2; 聂新宇1; 刘光炜2; 李山郎1; 苏宏杰1; 丁毅2; 钟兆伟2; 冼呈2; 花奇凯2
1.广西生物医药协同创新中心,广西 南宁 530021; 2.广西医科大学第一附属医院,广西 南宁 530021; 3.广西医科大学再生医学研究中心,广西 南宁 530021
关键词:
闭塞性血栓性脉管炎;  胫骨;  骨搬移
摘要:
目的:观察胫骨横向骨搬移术治疗下肢血栓闭塞性脉管炎的临床疗效及安全性。方法:2014年2月至2018年9月,采用胫骨横向骨搬移术治疗下肢血栓闭塞性脉管炎患者20例,均为男性。年龄31～56岁,中位数38岁。左侧12例,右侧8例。均有吸烟史,吸烟时间5～33年,中位数21年; 吸烟量每日5～60支,中位数35支。均经正规非手术或其他手术治疗无效。均有下肢静息痛和间歇性跛行。下肢单纯溃疡6例,单纯坏疽9例,溃疡和坏疽5例。病程1～7年,中位数3年。记录创面愈合时间,测量跛行距离、足趾皮肤温度及踝肱指数,采用疼痛视觉模拟量表(visual analogue scale,VAS)评分评价患者平卧位休息1 h后患肢静息痛程度,术后随访观察并发症发生情况。结果:所有患者均获随访,随访时间14～69个月,中位数40个月。术后1个月,患者的跛行距离较术前增加[(120±20)m,(1320±531)m,t=10.053,P=0.001]、足趾皮肤温度较术前增高[(28.79±0.58)℃,(32.22±1.01)℃,t=15.188,P=0.001]、踝肱指数较术前增大(0.44±0.03,0.84±0.09,t=23.150,P=0.001)、患肢静息痛VAS评分较术前降低[(5.30±1.78)分,(1.30±1.21)分,t=10.066,P=0.001]。20例患者中17例创面愈合,愈合时间(3.6±2.7)个月; 3例创面未愈合,其中1例经加强换药后创面最终愈合,1例术后3个月因足部缺血症状加重行小腿中上段截肢术,1例因截骨块感染自行在其他医院摘除骨块后行截肢术。至末次随访时,所有已愈合的溃疡或坏疽均未复发,均未出现胫骨骨折、钉道感染、截骨块延迟愈合、下肢深静脉血栓等并发症。结论:胫骨横向骨搬移术治疗下肢血栓闭塞性脉管炎,可以减轻患肢疼痛症状、增加跛行距离、提高足趾皮肤温度及踝肱指数,有利于创面愈合,且安全性较高。

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备注/Memo

备注/Memo:
基金项目:广西自然科学基金项目(2017GXNSFAA198293); 广西壮族自治区卫计委适宜技术项目(S2017032); 广西生物医药协同创新中心研究生创新创业项目(GCICB-IE-2017010); 广西医科大学青年科学基金项目(GXMUYSF201718) 通讯作者:花奇凯 E-mail:hqk100@yeah.net
更新日期/Last Update: 2020-07-20