小腿动脉病变的彩色多普勒超声研究

Color Doppler ultrasonographic study of crural arterial diseases

目的分析小腿动脉闭塞性病变的彩色多普勒超声特点及其在诊断中的作用和价值。方法将三支小腿主干动脉分为5个节段:胫前动脉、足背动脉、胫后动脉中上段(内踝上方)、胫后动脉下段(内踝处及下方)、腓动脉。根据声像图表现将小腿动脉病变程度分为4级:0级,正常管腔;Ⅰ级,管腔内径狭窄>50%;Ⅱ级,节段性闭塞;Ⅲ级,完全闭塞。患肢入选标准:小腿动脉各节段均能显示,至少1个小腿动脉节段受累(Ⅰ级、Ⅱ级或Ⅲ级),无股、腘动脉管腔狭窄及血流动力学改变。结果小腿动脉受累患肢共75条。三支主干动脉中单支受累53条(70.7%),二支受累14条(18.7%),三支均受累8条(10.6%)。在5个小腿动脉节段中胫前动脉受累最多(73.3%,55/75),其中节段性闭塞为最常见的类型,腓动脉受累最少(20.0%,15/75)。在受累患肢中,由于踝部代偿侧支的存在,1/3胫前-足背动脉及1/5胫后动脉下段与中上段血流相比明显好转。在5个小腿动脉节段中胫后动脉下段(内踝处过踝血流)及腓动脉受累与临床表现显著相关。结论彩色多普勒超声检查能够较好地显示小腿动脉的病变程度、侧支代偿情况等,有助于完整准确地评价下肢远端的血供情况。

Objective To study the characteristics of the crural arterial obstructive lesions by color Doppler ultrasonography and the value in diagnosis of the crural arterial lesions. Methods The three main crural arteries were divided into five segments; anterior tibial artery, dorsal artery, proximal and middle portion of posterior tibial artery（above internal ankle）,distal portion of posterior tibial artery（at the internal ankle and below）,and peroneal artery. The crural arterial lesions were classified as four grades according to the ultrasound image： Ⅲ- complete occlusion, Ⅱ-segmental occlusion, Ⅰ-lumen stenosis〉50%, 0-patent lumen. Those legs with dominant crural arterial lesion （grade Ⅰ , Ⅱ or Ⅲ） on at least one segments and without femoropopliteal arterial obstructions were selected. Results Totally 75 legs were involved. There were 53 legs （70.7%） with only 1 main artery damaged, 14 legs（18.7 % ） with 2 main arteries damaged, and 8 legs （10.6%） with all 3 main arteries damaged. Among the 5 arterial segments,the anterior tibial arterial lesions were found most frequently （73.3% ,55/75） ,in which the segmental occlusion （grade Ⅱ ） was the most common type. The peroneal arterial lesions appeared least （20. 0%, 15/75）. In the damaged main arteries, 1/3 anterior tibial dorsal arteries and 1/5 posterior tibial arteries had greatly improved distal vascularity compared with their proximal and middle portion,owing to the collateral arteries around the ankle. Statistical analysis showed that there was close relationship between the blood flow damage of the distal portion of the posterior tibial arterial segments （medial trans-ankle flow） and the peroneal artery with the clinical ischemic manifestations. Conclusions The dominant occlusive crural arterial lesions and the collateral arteries can be well imaged and diagnosed by color Doppler ultrasonography, which is helpful in providing accurate information of the blood supply of the distal part of the lower extremity.