胫骨横搬移和介入治疗重度下肢动脉闭塞症

Tibial transverse transport combined with endovascular intervention for severe arteriosclerosis obliterans of the lower extrem⁃ ity

摘要:

[目的] 比较胫骨横向搬移 （tibia transverse transport, TTT） 联合介入与单纯介入治疗重度下肢动脉硬化闭塞症 （ar- teriosclerosis obliterans, ASO） 的临床疗效。[方法] 回顾性分析 2018 年 5 月—2021 年 1 月于本院治疗的 86 例重度 ASO，根据医患沟通结果，46 例采用 TTT 联合介入治疗（复合组），40 例采用单纯介入治疗（介入组），比较两组治疗期、随访及影像结果。[结果]复合组手术时间 [(116.4±11.1) min vs (88.1±13.4) min, P＜0.05] 显著长于介入组，但是，前者在住院时间 [(21.5±4.0) d vs (24.7±4.5) d, P＜0.05] 、局部清创次数 [(1.4±0.5) 次 vs (2.3±0.9) 次, P＜0.05] 和抗生素使用时间 [(14.5±3.7) d vs (21.2±3.4) d, P＜0.05] 均显著优于后者。随访时间平均（18.8±4.3）个月，复合组恢复完全负重活动时间 [(5.0±1.6) 个月 vs (6.6±2.2) 个月, P＜0.05] 、创面愈合时间 [(4.2±1.8) 个月 vs (5.6±2.7) 个月, P＜0.05] 、创面愈合率（92.9% vs 76.3%, P＜0.05）和最终截肢率（13.0% vs 35.0%, P＜0.05） 均显著优于介入组。随时间推移，两组疼痛 VAS 评分、自我感受 VAS 评分、局部病灶评级均显著改善（P＜0.05），术前及术后 1 个月，两组间上述指标的差异均无统计学意义 （P＞0.05），术后 3 个月及末次随访时，复合组上述指标均显著优于介入组 （P＜ 0.05）。影像方面，随时间推移，两组血管显像均显著改善（P＜0.05），术前两组间血管造影情况的差异无统计学意义（P＞0.05）， 术后相应时间点复合组血管造影情况均显著优于介入组（P＜0.05）。[结论]介入联合 TTT 治疗下肢重度 ASO 可显著提升治疗效果，是一种有效和安全的治疗方法。

Abstract:

[Objective] To compare the clinical efficacy of tibial transverse transport (TTT) combined with endovascular intervention (EVI) versus EVI only for severe arteriosclerosis obliterans (ASO) of the lower extremity. [Methods] A retrospective study was performed on 86 patients who received surgical treatment for severe ASO in our hospital from May 2018 to January 2021. According to doctor-patient com- munication, 46 cases received TTT combined EVI (the combined group), while the remaining 40 patients received EVI only (the EVI group). The documents regarding treatment period, follow-up and imaging were compared between the two groups. [Results] Although the combined group consumed significantly longer operation time than the EVI group [(116.4±11.1) min vs (88.1±13.4) min, P＜0.05], the former proved sig- nificantly superior to the latter in terms of hospital stay [(21.5±4.0) days vs (24.7±4.5) days, P＜0.05], local debridement times [(1.4±0.5) times vs (2.3±0.9) times, P＜0.05] and longevity of antibiotic use [(14.5±3.7) days vs (21.2±3.4) days, P＜0.05]. All patients in both groups were followed up for (18.8±4.3) months on a mean. The combined group was significantly better than the EVI group in terms of time to re- sume full weight- bearing activity [(5.0 ± 1.6) months vs (6.6 ± 2.2) months, P＜0.05], wound healing time [(4.2 ± 1.8) months vs (5.6 ± 2.7) months, P＜0.05], wound healing rate (92.9% vs 76.3%, P＜0.05) and final amputation rate (13.0% vs 35.0%, P＜0.05). The pain VAS score, self-perceived VAS score and local lesion grade significantly improved in both group over time (P＜0.05), which were not statistically signifi-cant between the two groups before surgery and one month after surgery (P＞0.05), while became statistically significant between the two group 3 months after surgery and at the last follow-up (P＜0.05). As for imaging, vascular imaging presentations in both groups was signifi- cantly improved over time (P＜0.05), which was no significant difference between the two groups preoperatively (P＞0.05), whereas in the com- bined group was significantly better than that in the EVI group at all corresponding time points after surgery (P＜0.05). [Conclusion] This tibial transverse transport combined with endovascular intervention does considerably improve the therapeutic effect, is an effective and safe treatment for severe arteriosclerosis obliterans of the lower extremity.