摘要
目的探讨超细微血流成像(superb micro-vascular imaging,SMI)在评价胫骨横向骨搬移术治疗糖尿病足微血流灌注中的价值。方法回顾性分析2019年5月至2021年12月于山西医科大学第二医院行胫骨横向骨搬移术治疗糖尿病足的18例患者资料,男12例、女6例,年龄(64.89±14.34)岁(范围30~90岁)。所有患者均有不同程度的足溃疡。手术前后检查患者小腿及足部血管,比较彩色多普勒血流成像(color Doppler flow imaging,CDFI)及SMI对低速血流的显示率、SMI模式下手术前后第一跖背动脉起始处血流量和血管指数,以及手术前后新生血管数量和长度的变化。结果所有患者至少随访2个月。CDFI血流显示率为73.6%(106/144),SMI血流显示率为80.6%(116/144),差异有统计学意义(χ^(2)=4.68,P=0.031)。SMI显示患侧第一跖背动脉起始处术前、术后1周、术后1个月的血流量分别为3.48(1.33,7.56)ml/min、4.19(2.84,11.48)ml/min、3.72(2.52,11.40)ml/min,差异有统计学意义(χ^(2)=9.46,P=0.009)。术后1周和术后1个月血流量分别与术前比较差异均有统计学意义(P=0.033,P=0.003)。患侧第一跖背动脉起始处术前、术后1周、术后1个月的血管指数分别为3.84±3.60、6.51±4.92、6.82±5.36,差异有统计学意义(F=4.35,P=0.031);术后1周血管指数较术前增加,差异有统计学意义(P=0.026)。术后2个月,18例患者新生侧支数量为4.5(2,8)支,与术前的1(0,2)支的差异有统计学意义(Z=-3.57,P=0.001)。术后9例患者共18支新生血管长度较术前延长,5例患者术后可见2、3级分支建立,皮下浅层血管显示较术前明显清晰,且对侧有侧支循环建立。结论SMI技术可客观反映胫骨横向搬移术后患者血流动力学及微循环的变化,辅助临床初步预测患者预后并及时根据血流灌注调整个体治疗方案。
Objective To explore the clinical value of super micro vascular imaging(SMI)in evaluating the microvascular perfusion of diabetes foot treated by tibial transverse bone transport.Methods A retrospective study of 18 diabetic foot patients who underwent tibial transverse bone transport in the Second Hospital of Shanxi Medical University from May 2019 to December 2021 were analysed,including 12 males and 6 females,with an average age of 64.89±14.34 years(range,30-90 years).All patients had varying degrees of foot ulcer.Before and after the operation,the blood vessels of the patient's lower leg and foot were examined.The display rate of low-velocity blood flow was compared between color Doppler flow imaging(CDFI)and SMI;the blood flow and vascular index at the beginning of the first dorsal metatarsal artery before and after operation under SMI were compared;the number and length of new blood vessels were also compared before and after operation.Results All patients were followed up for at least 2 months.CDFI blood flow display rate was 73.6%(106/144),and SMI blood flow display rate was 80.6%(116/144),the difference was statistically significant(χ^(2)=4.68,P=0.031).Under SMI,the blood flow at the beginning of the first dorsal metatarsal artery on the affected side was measured before operation 3.38(1.33,7.56)ml/min,1 week after operation 4.19(2.84,11.48)ml/min and 1 month after operation 3.72(2.52,11.40)ml/min,with statistically significant difference(χ^(2)=9.46,P=0.009).There were statistically significant differences in blood flow at 1 week and 1 month after operation compared with that before operation(P=0.033,P=0.003).The vascular index at the beginning of the first dorsal metatarsal artery on the affected side was 3.84±3.60,6.51±4.92 and 6.82±5.36 before operation,1 week and 1 month after operation,respectively,and the differences were statistically significant(F=4.35,P=0.031).The vascular index in the first week after operation was significantly higher than that before operation(P=0.026).Up to the last follow-up,the number of new collaterals in 18 patients was 4.5(2,8),which was significantly different from 1(0,2)before operation(Z=-3.57,P=0.001).In total,the length of 18 new blood vessels in 9 patients was longer than that before operation,and the establishment of grade 2 and grade 3 branches were observed in 5 patients.The superficial subcutaneous vessels were showed more clarity than that before surgery,and there was collateral circulation on the opposite side.Conclusion SMI objectively reflects the changes of hemodynamics and microcirculation of patients after tibial transverse bone transport,and helps clinical preliminary predict the prognosis of patients and adjust individual treatment plan according to blood perfusion in time.
作者
李娟
武壮壮
籍坤
张永红
张刚
王兴华
李超
Li Juan;Wu Zhuangzhuang;Ji Kun;Zhang Yonghong;Zhang Gang;Wang Xinghua;Li Chao(Department of Ultrasound,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Shanxi Medical University,Taiyuan 030001,China;Department of Hospital Sensology,Children's Hospital of Shanxi Province,Taiyuan 030001,China;Department of Orthopaedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Physical Examination,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2023年第6期391-398,共8页
Chinese Journal of Orthopaedics
基金
山西省重点研发计划项目(201803D31126)
国家自然科学基金项目(82172439)
山西省应用基础研究计划(201901D111369)
作者简介
通信作者:王兴华,Email:wangxhus@163.com
