尺骨横向骨搬移技术在治疗上肢血栓闭塞性脉管炎中的初步应用

Preliminary application of ulnar cortex transverse transport technique in treatment of upper extremity thromboangiitis obliterans

目的探讨尺骨横向骨搬移技术治疗上肢血栓闭塞性脉管炎(thromboangiitis obliterans,TAO)的可行性和临床效果。方法回顾分析2019年1月—2022年7月收治且符合选择标准的7例男性上肢TAO患者临床资料。年龄32~50岁,平均40.1岁。病程6~24个月,平均13.6个月。吸烟史8~31年,平均18.4年。均伴有手指溃疡或坏疽,包括拇、示指1例,示、中指1例,中、环指1例,环指1例,环、小指3例。术前疼痛视觉模拟评分(VAS)为(9.1±0.7)分。所有患者均行尺骨横向骨搬移技术治疗。记录创面愈合时间及静息痛消失时间;采用VAS评分评估患者手术前后手部疼痛程度;术前及术后1个月检测血清IL-6水平变化;术前及术后3个月行患肢动脉CT血管造影(CT angiography,CTA)检查评估患者血管变化情况;术后1年基于Patwa和Krishnan分级系统评估临床效果。结果7例患者均获随访,随访时间12~17个月,平均13.7个月。所有患者溃疡均顺利愈合,创面愈合时间14~21 d,平均17.3 d;随访期间患者均无并发症发生,溃疡无复发。患者静息痛消失时间为8~15 d,平均12.1 d。术前及术后1个月患者血清IL-6水平分别为(25.1±5.9)pg/mL和(11.9±2.9)pg/mL,差异有统计学意义(t=5.363,P=0.002)。术后3个月CTA检查示上肢部分血管再通,侧支循环建立,较术前明显改善。术后1、7、28 d及6个月VAS评分分别为(6.4±0.8)、(3.7±0.8)、(0.6±0.8)、(0.1±0.4)分,均较术前显著改善(P<0.05);并且随时间延长逐渐降低,术后各时间点间差异均有统计学意义(P<0.05)。术后1年根据Patwa和Krishnan分级系统评价临床效果,7例患者均为优。结论尺骨横向骨搬移技术能够改善上肢TAO患者上肢血液循环,重建微循环,抑制炎症、促进溃疡愈合,缓解肢体疼痛。

Objective To investigate the feasibility and effectiveness of ulnar cortex transverse transport technique in treating upper extremity thromboangiitis obliterans(TAO).Methods A retrospective analysis was conducted on the clinical data of 7 male patients with upper extremity TAO who were admitted and met the inclusion criteria between January 2019 and July 2022.The patients ranged in age from 32 to 50 years,with a mean age of 40.1 years.The disease duration ranged from 6 to 24 months,averaging 13.6 months.The smoking history ranged from 8 to 31 years,with a mean of 18.4 years.All patients presented with finger ulcers or gangrene,including 1 case affecting the thumb and index finger,1 case affecting the index and middle fingers,1 case affecting the middle and ring fingers,1 case affecting only the ring finger,and 3 cases affecting the ring and little fingers.The preoperative visual analogue scale(VAS)score was 9.1±0.7.All patients underwent treatment with the ulnar cortext transverse transport technique.The wound healing time and the disappearance time of rest pain were recorded.The VAS score was used to assess the degree of hand pain before and after operation.Serum interleukin 6(IL-6)levels were measured before operation and at 1 month after operation.Computed tomography angiography(CTA)of the affected limb was performed before operation and at 3 months after operation to evaluate changes in blood vessels.The clinical outcomes were evaluated at 1 year after operation based on the Patwa and Krishnan grading system.Results All 7 patients were followed up 12-17 months,with an average of 13.7 months.All patients experienced successful healing of ulcers,with wound healing time ranging from 14 to 21 days,averaging 17.3 days.During the follow-up,no complication occurred,and there was no recurrence of ulcers.The disappear-ance time of rest pain ranged from 8 to 15 days,averaging 12.1 days.The pre-and post-operative(1-month)serum IL-6 levels were(25.1±5.9)pg/mL and(11.9±2.9)pg/mL,respectively,with a significant difference(t=5.363,P=0.002).CTA examination at 3 months after operation revealed partial revascularization of upper extremity arteries and establishment of collateral circulation,showing significant improvement compared to preoperative status.The VAS scores at 1,7,28 days,and 6 months postoperatively were 6.4±0.8,3.7±0.8,0.6±0.8,and 0.1±0.4,respectively,all of which significantly improved compared to preoperative scores(P<0.05).Furthermore,the VAS scores gradually decreased over time,with significant differences observed between postoperative time points(P<0.05).At 1 year after operation,the effectiveness of all 7 patients were evaluated as excellent based on the Patwa and Krishnan grading system.Conclusion The ulnar cortex transverse transport technique can improve blood circulation in the upper limb of patients with TAO,reconstruct microcirculation,inhibit inflammation,promote ulcer healing,and alleviate limb pain.