Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Guangxi Diabetic Foot Salvage Engineering Research Center, Nanning, China.
Orthop Surg. 2024 Sep;16(9):2132-2139. doi: 10.1111/os.14222. Epub 2024 Sep 7.
The clinical management of patients with chronic limb-threatening ischemia (CLTI) faces great challenges. Enhancing wound healing and limb preservation rates in this cohort is a critical objective. This study investigates the effectiveness of combining tibial cortex transverse transport (TTT) and endovascular therapy (EVT) for the treatment of patients with severe CLTI. We aim to evaluate the therapeutic results of this combined approach on the specified patient group.
We conducted a retrospective study to compare EVT with the combination of TTT and EVT in patients (Rutherford category 5 and above) with CLTI at Guangxi Medical University's First Affiliated Hospital from June 2017 to June 2023. This cohort was subjected to a follow-up period ranging from a minimum of 6 months to a maximum of 12 months. The primary outcome measures included amputation-free survival (AFS) (avoidance of above-ankle amputation or death from any cause), overall mortality, limb salvage rates, wound healing efficiency, and the technical efficacy of the applied treatments. A variety of statistical analyses including chi-square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses.
In this study, 131 patients with CLTI were included: 76 in the control group receiving only EVT treatment and 55 in the TTT + EVT group. The two groups were matched on demographic and clinical characteristics. In the TTT + EVT group, after more than 6 months of follow-up, 85.5% of patients achieved AFS, and wound healing was observed in 54.5% (30 of 55 patients). After more than 12 months of follow-up, 81.9% achieved AFS, with wound healing in 32 patients. Furthermore, after more than 24 months, 74.2% of patients remained amputation-free, with wound healing in all surviving patients. In the control group, after more than 6 months of follow-up, 72.4% of patients achieved AFS, and wound healing was observed in 51.3% (39 of 96 patients). After more than 12 months, 48.9% achieved AFS, with wound healing in 21 patients.
We found that combining therapy of TTT and EVT is safe and can be successfully administered in patients with CLTI and it enhances wound healing and AFS.
慢性肢体严重缺血（CLTI）患者的临床管理面临巨大挑战。提高该队列的伤口愈合率和肢体保留率是一个关键目标。本研究调查了联合胫骨皮质横向转运（TTT）和血管内治疗（EVT）治疗严重 CLTI 患者的效果。我们旨在评估该联合治疗方法对特定患者群体的治疗效果。
我们进行了一项回顾性研究，比较了 2017 年 6 月至 2023 年 6 月在广西医科大学第一附属医院接受 CLTI（Rutherford 分类 5 级及以上）治疗的患者中 EVT 与 TTT 联合 EVT 的治疗效果。该队列的随访时间从最短 6 个月到最长 12 个月不等。主要结局指标包括免于截肢生存率（AFS）（避免踝关节以上截肢或任何原因导致的死亡）、总死亡率、肢体存活率、伤口愈合效率以及应用治疗方法的技术效果。进行了多种统计分析，包括卡方检验、Fisher 确切检验以及 Pearson 和 Spearman 相关分析。
本研究共纳入 131 例 CLTI 患者：对照组仅接受 EVT 治疗 76 例，TTT+EVT 组 55 例。两组在人口统计学和临床特征上相匹配。在 TTT+EVT 组中，超过 6 个月的随访后，85.5%的患者达到 AFS，54.5%（55 例中的 30 例）患者的伤口愈合。超过 12 个月的随访后，81.9%的患者达到 AFS，32 例患者的伤口愈合。此外，超过 24 个月后，74.2%的患者免于截肢，所有存活患者的伤口均愈合。在对照组中，超过 6 个月的随访后，72.4%的患者达到 AFS，51.3%（96 例中的 39 例）患者的伤口愈合。超过 12 个月后，48.9%的患者达到 AFS，21 例患者的伤口愈合。
我们发现 TTT 联合治疗是安全的，可以成功应用于 CLTI 患者，并提高伤口愈合率和 AFS。
