胫骨横向骨搬移治疗下肢血栓闭塞性脉管炎的临床研究

Clinical study of transverse tibial bone displacement in the treatment of lower extremity thromboangiitis obliterans

目的分析胫骨横向骨搬移(TTBT)治疗下肢血栓闭塞性脉管炎(TAO)效果,及其对血清内皮损伤因子、疼痛因子的影响。方法选择2017年7月至2022年6月石家庄平安医院收治的下肢TAO患者92例为研究对象,根据手术方式不同将92例下肢TAO患者分为TTBT组和对照组,每组46例。对照组接受置管溶栓及球囊扩张术,TTBT组接受TTBT治疗。观察并比较两组皮肤温度恢复时间、皮肤颜色恢复时间,以及术前、术后半年患肢踝肱指数(ABI)、间歇性跛行距离,血清血管内皮生长因子(VEGF)、低氧诱导因子1α(HIF-1α)、血管性血友病因子(vWF)及血栓素B2(TXB2)等内皮损伤因子,血清5-羟色胺(5-HT)、P物质(SP)、去甲肾上腺素(NE)等疼痛因子水平。结果TTBT组皮肤温度恢复时间、皮肤颜色恢复时间分别为(10.36±1.32)、(5.07±0.53)d,短于对照组的(12.45±1.50)、(6.28±0.65)d,差异均有统计学意义(P<0.05)。术后半年,TTBT组患肢ABI、间歇性跛行距离分别为0.86±0.11、(2546.52±258.28)m,大于对照组的0.77±0.09、(2103.06±226.23)m,差异均有统计学意义(P<0.05)。术后半年,TTBT组血清VEGF、HIF-1α、vWF、TXB2水平分别为(36.87±3.98)ng/L、(2.64±0.29)ng/L、(149.97±17.62)%、(140.38±17.62)ng/L,低于对照组的(44.09±4.82)ng/L、(3.17±0.34)ng/L、(186.50±21.08)%、(178.95±20.11)ng/L,差异均有统计学意义(P<0.05)。术后半年,TTBT组血清5-HT、SP、NE水平分别为(0.24±0.03)μmol/mL、(1.51±0.17)pg/mL、(60.37±6.41)ng/mL,均低于对照组的(0.31±0.05)μmol/mL、(1.87±0.21)pg/mL、(75.25±9.17)ng/mL,差异均有统计学意义(P<0.05)。结论TTBT治疗下肢TAO可重建下肢远端侧支循环,保护血管内皮,改善局部缺血状况,促进患者皮肤恢复,增强患者运动功能,降低疼痛因子、内皮损伤因子水平。

Objective To study the effect of tibial transverse bone transfer(TTBT)in the treatment of lower limb thromboangiitis obliterans(TAO),and its impact on serum endothelial injury factors and pain factors.Methods A total of 92 patients with lower limb TAO who were admitted to Shijiazhuang Ping'an Hospital from July 2017 to June 2022 were selected as the research subjects.The 92 patients with lower limb TAO were divided into TTBT group and control group according to the different surgery method,with 46 patients in each group.The control group received catheter thrombolysis and balloon dilation,while the TTBT group received TTBT.Postoperative recovery indicators such as skin temperature recovery time and skin color recovery time in the two groups,ankle brachial index(ABI)of the affected limb,intermittent claudication distance before surgery and six months after surgery,serum vascular endothelial growth factor(VEGF),hypoxia inducible factor 1α(HIF-1α),vascular hemophilia factor(vWF),thromboxane B2(TXB2)and other endothelial injury factors,as well as serum levels of pain factors such as serotonin(5-HT),substance P(SP),and norepinephrine(NE)before and six months after surgery were observed and compared.Results The recovery time of skin temperature and skin color in the TTBT group were(10.36±1.32)and(5.07±0.53)days,which were shorter than those in the control group[(12.45±1.50)and(6.28±0.65)days],and the differences were statistically significant(P<0.05).Six months after surgery,the ABI and intermittent claudication distance of the affected limb in the TTBT group were 0.86±0.11 and(2546.52±258.28)m,which were greater of longer than 0.77±0.09 and(2103.06±226.23)m in the control group,the differences were statistically significant(P<0.05).Six months after surgery,the serum levels of VEGF,HIF-1α,vWF and TXB2 in the TTBT group were(36.87±3.98)ng/L,(2.64±0.29)ng/L,(149.97±17.62)%and(140.38±17.62)ng/L,which were lower than(44.09±4.82)ng/L,(3.17±0.34)ng/L,(186.50±21.08)%and(178.95±20.11)ng/L in the control group,with statistical significance(P<0.05).Six months after surgery,the serum levels of 5-HT,SP,and NE in the TTBT group were(0.24±0.03)μmol/mL,(1.51±0.17)pg/mL and(60.37±6.41)ng/mL,which were all lower than(0.31±0.05)μmol/mL,(1.87±0.21)pg/mL and(75.25±9.17)ng/mL in the control group,with statistical significance(P<0.05).Conclusion TTBT treatment of lower extremity TAO can reconstruct distal collateral circulation of lower extremity,protect vascular endothelium,improve ischemic condition,promote skin recovery,enhance motor function,reduce the levels of pain factors and endothelial injury factors.