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[1]楊思捷,陳炎,鄺曉聰,等.脛骨橫向骨搬移術(shù)治療下肢血栓閉塞性脈管炎[J].中醫(yī)正骨,2020,32(07):58-61.
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脛骨橫向骨搬移術(shù)治療下肢血栓閉塞性脈管炎()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期數(shù):
2020年07期
頁碼:
58-61
欄目:
臨床報道
出版日期:
2020-07-20

文章信息/Info

作者:
楊思捷1陳炎2鄺曉聰3莊勝1何立環(huán)2鎮(zhèn)普祥2聶新宇1劉光煒2李山郎1蘇宏杰1丁毅2鐘兆偉2冼呈2花奇凱2
1.廣西生物醫(yī)藥協(xié)同創(chuàng)新中心,廣西 南寧 530021; 2.廣西醫(yī)科大學(xué)第一附屬醫(yī)院,廣西 南寧 530021; 3.廣西醫(yī)科大學(xué)再生醫(yī)學(xué)研究中心,廣西 南寧 530021
關(guān)鍵詞:
閉塞性血栓性脈管炎 脛骨 骨搬移
摘要:
目的:觀察脛骨橫向骨搬移術(shù)治療下肢血栓閉塞性脈管炎的臨床療效及安全性。方法:2014年2月至2018年9月,采用脛骨橫向骨搬移術(shù)治療下肢血栓閉塞性脈管炎患者20例,均為男性。年齡31~56歲,中位數(shù)38歲。左側(cè)12例,右側(cè)8例。均有吸煙史,吸煙時間5~33年,中位數(shù)21年; 吸煙量每日5~60支,中位數(shù)35支。均經(jīng)正規(guī)非手術(shù)或其他手術(shù)治療無效。均有下肢靜息痛和間歇性跛行。下肢單純潰瘍6例,單純壞疽9例,潰瘍和壞疽5例。病程1~7年,中位數(shù)3年。記錄創(chuàng)面愈合時間,測量跛行距離、足趾皮膚溫度及踝肱指數(shù),采用疼痛視覺模擬量表(visual analogue scale,VAS)評分評價患者平臥位休息1 h后患肢靜息痛程度,術(shù)后隨訪觀察并發(fā)癥發(fā)生情況。結(jié)果:所有患者均獲隨訪,隨訪時間14~69個月,中位數(shù)40個月。術(shù)后1個月,患者的跛行距離較術(shù)前增加[(120±20)m,(1320±531)m,t=10.053,P=0.001]、足趾皮膚溫度較術(shù)前增高[(28.79±0.58)℃,(32.22±1.01)℃,t=15.188,P=0.001]、踝肱指數(shù)較術(shù)前增大(0.44±0.03,0.84±0.09,t=23.150,P=0.001)、患肢靜息痛VAS評分較術(shù)前降低[(5.30±1.78)分,(1.30±1.21)分,t=10.066,P=0.001]。20例患者中17例創(chuàng)面愈合,愈合時間(3.6±2.7)個月; 3例創(chuàng)面未愈合,其中1例經(jīng)加強(qiáng)換藥后創(chuàng)面最終愈合,1例術(shù)后3個月因足部缺血癥狀加重行小腿中上段截肢術(shù),1例因截骨塊感染自行在其他醫(yī)院摘除骨塊后行截肢術(shù)。至末次隨訪時,所有已愈合的潰瘍或壞疽均未復(fù)發(fā),均未出現(xiàn)脛骨骨折、釘?shù)栏腥尽⒔毓菈K延遲愈合、下肢深靜脈血栓等并發(fā)癥。結(jié)論:脛骨橫向骨搬移術(shù)治療下肢血栓閉塞性脈管炎,可以減輕患肢疼痛癥狀、增加跛行距離、提高足趾皮膚溫度及踝肱指數(shù),有利于創(chuàng)面愈合,且安全性較高。

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備注/Memo

備注/Memo:
基金項目:廣西自然科學(xué)基金項目(2017GXNSFAA198293); 廣西壯族自治區(qū)衛(wèi)計委適宜技術(shù)項目(S2017032); 廣西生物醫(yī)藥協(xié)同創(chuàng)新中心研究生創(chuàng)新創(chuàng)業(yè)項目(GCICB-IE-2017010); 廣西醫(yī)科大學(xué)青年科學(xué)基金項目(GXMUYSF201718) 通訊作者:花奇凱 E-mail:[email protected]
更新日期/Last Update: 2020-07-20