Kelkar Bharat R
Hospital for Orthopaedic and Reconstructive Surgery, Mumbai Naka, Nasik, India.
Clin Orthop Relat Res. 2003 Jul(412):234-40. doi: 10.1097/01.blo.0000072461.53786.4d.
Between May 1990 and April 2000, 61 patients with severe occlusive arterial disease (44 with thromboangiitis obliterans, 13 with atherosclerosis, and four with diabetes mellitus), who had not responded to previous nonsurgical and surgical treatment and had chronic critical ischemia in the lower limbs, had corticotomy near major neurovascular bundles and periosteal elevation along the whole length of the bone. This corticotomy consisted of elevation of a longitudinal window in the lateral cortex of the tibia to induce formation of neovascularity. The neovascularity is a part of the inflammatory response to fracture and periosteal elevation. The longest followup was 10 years and the shortest was 6 months. In 50 of 61 patients there was complete relief from pain at rest and indefinite postponement of amputation. Digital subtraction angiography studies before and after surgery showed the presence of a new vascular collateral network across the affected arteries, a process that improved the circulatory status of the ischemic limbs. The induced neovascularity acted as endogenous biologic bypass conduits and seemed to provide relief for patients with small and diffuse artery disease, when vascular reconstruction otherwise was impossible.
1990年5月至2000年4月期间，61例患有严重闭塞性动脉疾病的患者（44例血栓闭塞性脉管炎、13例动脉粥样硬化、4例糖尿病），此前接受非手术和手术治疗均无效且下肢患有慢性严重缺血，在主要神经血管束附近进行了皮质切开术，并沿骨的全长进行了骨膜剥离。这种皮质切开术包括在胫骨外侧皮质掀起一个纵向窗口以诱导新生血管形成。新生血管形成是对骨折和骨膜剥离的炎症反应的一部分。最长随访时间为10年，最短为6个月。61例患者中有50例静息痛完全缓解，截肢被无限期推迟。手术前后的数字减影血管造影研究显示，在受影响动脉周围出现了新的血管侧支网络，这一过程改善了缺血肢体的循环状况。诱导形成的新生血管起到了内源性生物旁路管道的作用，对于小而弥漫性动脉疾病且无法进行血管重建的患者似乎提供了缓解。
