【作者】 章泰丰； 陆茂德； 仇继任； 罗坤烈； 葛艺； 罗华； 廖振南；

【Author】 Taifeng Zhang;Maode Lu;Jiren Qiu;Kunlie Luo;Yi Ge;Hua Luo;Zhennan Liao;Osteoarticular Surgery, Qinzhou Second People’s Hospital;

【机构】 钦州市第二人民医院骨关节外科；

【摘要】 目的初步探讨ilizarov胫骨横向骨搬移术在治疗下肢血栓闭塞性脉管炎、动脉硬化性闭塞性脉管炎中的临床效果。方法选取2017年2月—2019年4月在本院行Ilizarov胫骨横向骨搬移术治疗下肢血栓闭塞性脉管炎、动脉硬化性闭塞性脉管炎的16例患者,共22个患肢,术中在患肢胫骨中上段内侧面上做一约1.5 cm×5cm骨窗,安装胫骨横向骨搬移手术并外固定架,术后第2天开始以每天1mm的速度分三次向外牵拉,14天后改为向骨面回调,骨块调回骨面后外固定支架继续维持一月后拆除。结果 16例患者均获得随访,随访时间8～24个月,随访病例中15个患肢的缺血症状明显改善,静息痛消除,患肢皮温较术前增高。2个患肢术后1个月足趾坏死界限恒定,行坏死足趾截除,1个年轻下肢血栓闭塞性脉管炎患者患肢术后症状缓解后6个月后再次出现肢体疼痛并缺血坏死最后行胫骨结节下截肢术,伤口顺利愈合。4个患肢术后12个月回院复查下肢动脉CTA提示:患肢、甚至健侧肢体动脉出现大量血管网,出现闭塞血管再通。结论通过ilizarov胫骨横向骨搬移术治疗下肢血栓闭塞性脉管炎、动脉硬化性闭塞性脉管炎可明显恢复患肢的血运状况,改善临床症状,提高患者的保肢率,安全性较高,值得推广使用。更多还原

【Abstract】 purpose: our wanted to discuss the clinic result of lower limb Thromboangiitis obliterans and Arteriosclerotic obliterative vasculitis with the Ilizarove Tibia Transvers Transport operation. Method: we selected 16 patients with lower limb Thromboangiitis obliterans and Arteriosclerotic obliterative vasculitis who have taken the operation of Ilizarove Tibia Transvers Transport operation in our hospital from February 2017 to April 2019, there were total 22 lower limbs in 16 patients with above diseases, in the operation we made a bone window of about 1.5 cm x 5 cm on the medial surface of the middle and upper segment of the tibia to install the Tibia Transvers Transport external fixation. In the 2 nd day after the surgery,we started to strain outward the bone slice 1 mm per day by 3 times, we would reverse this process after 14 days of outward-straining, which would also take 14 days. After that, the external fixation would be disassembled in 1 month. Result: the16 patients were all followed-up in about 8-24 months, 15 patients of them had the symptoms of ischemia in the ill limbs were significantly improved, the rest pain was eliminated, and the skin temperature of the limbs was higher than that before operation. 2 patients ’ toe necrosis had not expanded in a mouth after theoperation and the toes were amputated. 1 young patient with thromboangiitis obliterans of lower extremities suffered from limb pain and ischemic necrosis in 6 months after the symptoms were relieved. Subtubercular tibial amputation was performed and the wound healed. 4 patients reviewed the lower limb CTA in 12 months and the result showed the ill limb and the healthy limb regenerated plenty of vascellum and recanalized the occluded vessels. Result: the Ilizarove Tibia Transvers Transport operation could significantly improve the blood circulation situation, alleviate the clinic symptoms, protect patient from high amputation rate,have higher safety rate in the lower limb Thromboangiitis obliterans and Arteriosclerotic obliterative vasculitis patient, it is worth popularizing.更多还原