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(arteriosclerosis 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。
[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 significant 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 EV
作者
赵永鑫
覃忠
丁毅
余杰
苏永锋
刘杰
陈业平
花奇凯
陈炎
ZHAO Yong-xin;QIN Zhong;DING Yi;YU Jie;SU Yong-feng;LIU Jie;CHEN Ye-ping;HUA Qi-kai;CHEN Yan(Collabora-tive Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Min-istry,Guangxi Medical University,Nanning,Guangxi 530021,China;Department of Endovascular Surgery,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Orthopedics and Joint Surgery,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Diabetes Foot Salvage Engineering Research Center,Nanning 530021,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2023年第15期1368-1373,共6页
Orthopedic Journal of China
基金
国家自然科学基金项目(编号:82060406
81601930)
中国博士后科学基金项目(编号:2019M650235)
广西医科大学高水平创新团队及杏湖学者计划项目
广西壮族自治区自然科学基金项目(编号:2017GXNSFAA198318)
广西壮族自治区南宁市青秀区重点研发计划项目(2021003,2020053)
广西医科大学第一附属医院临床研究攀登计划项目(编号:YYZS2020010)。
关键词
下肢动脉硬化闭塞症
胫骨横向骨搬移
介入治疗
溃疡
牵张成骨
lower extremity
arteriosclerotic obliterans
tibial transverse transport
endovascular intervention
ulcer
distraction osteo⁃genesis
