The Clinical Investigation Of Treating Thromboangiitis Obliterans With Tibial Transverse Bone Transport And Vascular Regenerative Surgery

Objective:To investigate the application of the tibial transverse bone transport and vascular regenerative surgery in thromboangiitis obliterans.Methods:From September 2014 to August 2016,22(17 men,5 women)patients,age from 58 to 77 years,average age 66.9 years old,with thromboangiitis obliterans underwent the tibial transverse bone transport and vascular regenerative surgery.Postoperative smoking was strictly prohibited and keep warmth.Began to detect degree of blood oxygen saturation after operation seven days,using visual analogue scale(VAS)assessment of limb pain,observe intermittent claudication distance,measure the change of the ankle brachial index(ABI)and acral skin,healing of foot ulcers.The vascular regeneration of the lower limb was observed by angiography after six months.Results:On the day after tibial transverse bone transport and vascular regenerative surgery,all patients pain had relief.20 patients limb pain had been relieved obviously,while only 1 case pain had no obvious relief six months postoperatively.VAS scores of 20 patients decreased from 7.2±0.3 preoperatively to 2.1 ±0.2 postoperatively,and the difference was statistically significant(P=0.028).The day before the operation the foot skin temperature was 29.1 ±0.2℃,an average foot temperature was 290C,to the postoperative follow-up was 32.2± 1.4℃,the average temperature of foot was 31±1℃,the difference was statistically significant(P =0.033).The distance of intermittent claudication became long compared with preoperative.20 patients with intermittent claudication distance increased by 1437.3 meter.14 patients of the 16 foot ulcer healed gradually through the periodic dressing,and 2 patients with foot ulcers healed after debridement.The angiograph indicated that the number of vessels in the lower leg and foot obvious increasing at 18 patients.The number of vessels in the leg increased but in the foot increased little in 2 patients.And the vessels in the leg and foot of the 1 patients were not obviously regenerated.In all the 20 patients,the degree of blood oxygen saturation was significantly higher than that before operation,only 1 case increased not obvious.The ABI increased from 0.28±0.02 preoperatively to 0.9±0.03 postoperatively(average 0.9),the difference was statistically significant(P=0.015).None of enrolled patients had progressed to limb necrosis and amputation.Neither symptoms nor ABI became worse during the 6-16(average 10.7)months follow-up period.No fracture and pin track infection complications happened.The clinical symptoms of the 1 patient was not significantly relieved,angiography showed that no vascular regeneration.1 patient died of cardiovascular events during treatment.Conclusion:The tibial transverse bone transport and vascular regenerative surgery showed good safety,short and mid-term therapeutic effect to treat the thromboangiitis obliterans.