Li Zhongyu, Smith Beth Paterson, Holden Martha, Koman L Andrew
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA.
J Reconstr Microsurg. 2009 Feb;25(2):133-7. doi: 10.1055/s-0028-1103511. Epub 2008 Dec 1.
Patients with critical peripheral vascular disease and nonhealing toe ulcers secondary to collagen vascular disease often require toe amputation when nonsurgical measures fail to control their symptoms. The aim of this study was to evaluate the effectiveness of periarterial sympathectomy (PAS) of the foot/ankle in patients with unreconstructable vaso-occlusive disease and nonhealing digit ulcers unresponsive to nonsurgical measures. Five patients (seven feet and nine toe ulcers) were treated with PAS of their involved foot and followed for a minimal of 3 years (3 to 7 years). The technique included PAS of the dorsalis pedis, posterior tibial and anterior tibial arteries. Eight toe ulcers healed uneventfully within 3 months after surgery. Only one patient developed a new ulcer 5 years after PAS. The mean visual analog pain scale improved from 5.7 to 1 (P<0.03). The mean Wake Forest University (WFU) scale improved from 1.8 to 0.5 (P=0.07). There was no change in the WFU numbness score or the McCabe Cold sensitivity scale. The results suggest that foot/ankle PAS is a beneficial salvage treatment option for patients with non-reconstructable, vaso-occlusive disease that ameliorates foot symptoms, facilitates healing of toe ulcerations, and reduces the incidence of toe amputations.
患有严重外周血管疾病且因胶原血管病导致脚趾溃疡不愈合的患者，在非手术措施无法控制其症状时，往往需要进行脚趾截肢。本研究的目的是评估足部/踝关节周围动脉交感神经切除术（PAS）对患有不可重建性血管闭塞性疾病且非手术措施治疗无效的趾溃疡患者的有效性。五名患者（七只脚和九个脚趾溃疡）接受了患侧足部的PAS治疗，并随访至少3年（3至7年）。该技术包括对足背动脉、胫后动脉和胫前动脉进行PAS。八个脚趾溃疡在手术后3个月内顺利愈合。只有一名患者在PAS术后5年出现了新的溃疡。视觉模拟疼痛量表平均分从5.7降至1（P<0.03）。维克森林大学（WFU）量表平均分从1.8降至0.5（P=0.07）。WFU麻木评分或麦凯布冷敏量表没有变化。结果表明，足部/踝关节PAS对于患有不可重建性血管闭塞性疾病的患者是一种有益的挽救治疗选择，可改善足部症状，促进脚趾溃疡愈合，并降低脚趾截肢的发生率。
