Belov S
Centers for Treatment of Congenital Vascular Defects, Hamburg, Germany.
Semin Vasc Surg. 1993 Dec;6(4):245-51.
The progress in the treatment of congenital vascular-bone diseases in lower extremities caused by vascular malformations has been reviewed, along with an analysis of our clinical material and methods of treatment, and the results of our attempts to correct lower limb length discrepancy by early and direct vascular surgery directed at the cause of the bony changes. This experience leads us to the following conclusions: 1. Congenital vascular-bone diseases in lower extremities have a hemodynamic pathogenesis. The resulting bone changes can be caused by each of the different types of congenital vascular defects, or by a combination of them, with the resultant bone elongation or shortening due to hemodynamic and metabolic effects on the bone growth areas. 2. The recommended approach demands early, active, and causal treatment. 3. Operative techniques must be individualized and often seem unconventional because of the polymorphism of congenital vascular defects and specific differences in their anatomic and hemodynamic features. In severe cases, vascular surgery must be combined with other non-hemodynamic operations and nonsurgical methods (eg, orthopedic surgery, embolotherapy). 4. Early and active vascular surgery in childhood allows the correction of congenital lower limb length discrepancy, as judged by late follow-up evaluation.
本文回顾了由血管畸形引起的下肢先天性血管-骨疾病的治疗进展，分析了我们的临床资料、治疗方法，以及我们尝试通过针对骨改变原因的早期直接血管手术来纠正下肢长度差异的结果。这些经验使我们得出以下结论：1. 下肢先天性血管-骨疾病具有血液动力学发病机制。由此产生的骨改变可由每种不同类型的先天性血管缺陷单独引起，或由它们的组合引起，由于对骨生长区域的血液动力学和代谢影响，导致骨伸长或缩短。2. 推荐的方法需要早期、积极且针对病因的治疗。3. 手术技术必须个体化，并且由于先天性血管缺陷的多态性及其解剖和血液动力学特征的特定差异，往往看起来不常规。在严重病例中，血管手术必须与其他非血液动力学手术和非手术方法（如矫形外科手术、栓塞治疗）相结合。4. 根据后期随访评估，儿童期早期积极的血管手术可纠正先天性下肢长度差异。
