Wang Bin, Liu Wei, Huo Yongxin, Gong Zhongping, Wang Wei, Hao Ruizheng, Fang Jun, Zhang Jian, Jiang Wenping
Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000,
Department of Hand Surgery, Repair and Reconstruction Surgery, Lower Limb Vascular Disease, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 Dec 15;32(12):1576-1580. doi: 10.7507/1002-1892.201806124.
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.
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.
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 ( =17.510, =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%.
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.
探讨股-股动脉搭桥联合胫骨横向骨搬移术治疗下肢动脉硬化闭塞症（ASO）或合并糖尿病足的疗效。
2014年3月至2016年6月，对9例下肢ASO或合并糖尿病足患者行股-股动脉搭桥联合胫骨横向骨搬移术。所有患者均为男性，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）。所有病例均为重度单侧髂动脉闭塞，其中左侧5例，右侧4例。7例合并股浅和/或腘下动脉病变。7例为ASO，2例为ASO合并糖尿病足（Wagner 4级）；所有ASO按Fontaine标准均为Ⅳ级。所有患者术前均有静息痛，踝肱指数为0.24±0.12。股-股动脉搭桥术中，7例使用人工血管，2例使用自体大隐静脉。胫骨横向骨搬移于术后第8天开始，每天1 mm，每6小时1次；搬移2～3周后回退。整个疗程10～14周。
胫骨横向骨搬移切口1例坏死，换药后愈合。针孔处无明显并发症。其他患者无切口并发症。胫骨横向骨搬移后足部创面肉芽组织生长迅速，2～3周后创面缩小。9例患者均获随访12～32个月（平均19个月）。术后2个月踝肱指数为0.67±0.09，明显高于术前（ =17.510， =0.032）。所有足部溃疡创面均愈合，愈合时间为6.7～9.4周（平均7.7周）。随访期间，彩色多普勒超声或CT检查显示移植血管通畅。术后12～14周拆除外固定架。1例术后14个月死于急性心肌梗死，无淋巴漏发生。术后1年股-股动脉搭桥通畅率为100%。胫骨横向骨移植术后4～6个月与胫骨愈合。末次随访时，有效率为100%。
股-股动脉搭桥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。
