Two cases of recurrent thromboangiitis obliterans treated with tibial transverse transport surgery twice
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摘要: 该文对吉林大学第二医院（以下简称本院）手外科收治的2例行胫骨横向骨搬移（TTT）手术治疗血栓闭塞性脉管炎患者的临床资料进行总结分析,并综述最新文献。2019年1月收治1例31岁男性患者,其左足𧿹趾末端创面经久不愈伴左下肢间歇性疼痛,入本院后行TTT手术治疗。术后1周复查见足部创面面积缩小并结痂。术后6周复查见足部创面基本愈合。术后20个月时,左下肢间歇性疼痛复发,且左足𧿹趾末端部分组织出现变黑坏死征象,患者再次入本院行TTT手术治疗。2019年9月收治1例48岁男性患者,其左足第4趾于外院行部分切除后形成的创面不愈伴疼痛,入本院后行TTT手术治疗,同时对创面行清创缝合,半个月后创面愈合,出院。术后9个月时,患者因左足第4趾坏疽伴疼痛再次入本院,再次行TTT手术治疗及残余第4趾截趾术。前述2例患者第1次TTT手术后复发的疼痛等症状,经再次行TTT手术治疗后均有所缓解。这表明TTT手术治疗血栓闭塞性脉管炎具有一定的时效性,对于复发患者而言,只要符合TTT手术治疗的适应证,可再次行该治疗以改善症状。Abstract: This article summarized and analyzed the clinical data of two patients with thromboangiitis obliterans who were admitted to the Department of Hand Surgery of the Second Hospital of Jilin University (hereinafter referred to as our hospital) and underwent tibial transverse transport (TTT) surgery, and reviewed the latest literature. In January 2019, a 31-year-old male patient was admitted with a persistent wound on the end of his left big toe and intermittent pain in his left lower limb. After admission to our hospital, he underwent TTT surgery. A follow-up examination one week after surgery showed that the foot wound was reduced in area and scabbed. At 6 weeks postoperatively, the foot wound was nearly healed. At 20 months postoperatively, intermittent pain in the left lower limb recurred, accompanied by signs of partial tissue necrosis and blackening at the end of the left big toe. The patient was readmitted to our hospital for TTT surgery. In September 2019, a 48-year-old male patient was admitted to our hospital with a non-healing wound accompanied by pain on the fourth toe of his left foot that was partially resected at another hospital. After admission, he underwent TTT surgery and debridement and suture of the wound. The wound healed after half a month, and the patient was discharged from the hospital. At 9 months postoperatively, the patient was admitted to our hospital again due to gangrene and pain in the fourth toe of his left foot, and underwent TTT surgery again and amputation of the remaining fourth toe. The pain and other symptoms that recurred in the two aforementioned patients after their first TTT surgery were alleviated after they underwent the TTT surgery again. This indicates that TTT surgery for thromboangiitis obliterans has a certain time-limited effect. For patients with recurrence, if they meet the indications for TTT surgery, this treatment can be repeated to improve symptoms.
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参考文献
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图 1 两次行胫骨横向骨搬移手术治疗例1患者复发性血栓闭塞性脉管炎的效果。1A.第1次术前足部外观,可见左足𧿹趾末端存在缺血性溃疡；1B.第1次术前血管造影,可见患肢（左、右侧图分别为侧、正位图）局部循环受损；1C.第1次术后1周,胫骨外固定架安装稳固,患肢无明显并发症；1D.第1次术后1周,患足创面面积缩小并结痂；1E.第1次术后6周,患足创面基本愈合；1F.第1次术后6周双下肢血管造影,可见患肢（图中右侧）局部血液循环显著改善；1G.第2次术中,创面清创后即刻；1H.第2次术后6周,可见创面面积缩小并结痂
Table 1. 两次行胫骨横向骨搬移手术治疗例1复发性血栓闭塞性脉管炎患者各时间点的踝肱指数和VAS评分与肢端皮肤温度
手术次数及时间 踝肱指数 VAS评分（分） 肢端皮肤温度（℃） 足跟底 中足背 中足底 中足内 中足外 第1次手术 术前 0.40 9 32.8 34.0 33.1 32.4 33.0 术后3 d 0.45 7 32.8 34.3 33.1 32.4 33.0 术后7 d 0.50 3 32.9 34.5 33.2 32.5 33.1 术后15 d 0.60 3 33.0 34.8 33.3 32.7 33.3 术后1个月 0.65 1 33.2 35.0 33.4 32.9 33.4 术后3个月 0.65 0 33.3 35.1 33.5 33.0 33.4 第2次手术 术前 0.45 9 32.5 33.8 32.8 32.1 32.8 术后3 d 0.50 8 32.6 34.1 32.9 32.2 32.9 术后7 d 0.55 5 32.8 34.2 33.0 32.4 33.0 术后15 d 0.60 3 32.9 34.4 33.1 32.6 33.1 术后1个月 0.60 2 33.0 34.6 33.2 32.7 33.3 术后3个月 0.60 1 33.1 34.8 33.3 32.8 33.3 注：VAS指视觉模拟评分法 
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Table 2. 两次行胫骨横向骨搬移手术治疗例2复发性血栓闭塞性脉管炎患者各时间点的踝肱指数和VAS评分与肢端皮肤温度
手术次数及时间 踝肱指数 VAS评分（分） 肢端皮肤温度（℃） 足跟底 中足背 中足底 中足内 中足外 第1次手术 术前 0.50 9 34.1 34.3 33.0 33.0 33.9 术后3 d 0.50 8 34.3 34.5 33.2 33.2 34.0 术后7 d 0.50 4 34.5 34.7 33.5 33.5 34.2 术后15 d 0.55 3 34.8 35.0 33.7 33.7 34.6 术后1个月 0.60 2 35.0 35.0 33.9 33.9 34.9 术后3个月 0.70 0 35.0 35.1 34.0 34.0 35.0 第2次手术 术前 0.45 9 33.9 34.0 32.8 32.8 33.3 术后3 d 0.45 8 34.0 34.2 32.9 33.0 33.4 术后7 d 0.50 6 34.2 34.5 33.2 33.2 33.6 术后15 d 0.50 4 34.3 34.8 33.4 33.4 33.7 术后1个月 0.55 2 34.5 34.9 33.5 33.5 33.9 术后3个月 0.60 1 34.8 35.0 33.6 33.5 34.0 注：VAS指视觉模拟评分法
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