肢体军训伤后继发动脉血栓形成的导管接触性溶栓治疗

摘要

目的：探讨应用导管接触性溶栓（CDT）治疗肢体军训伤后继发动脉血栓形成的临床效果。方法回顾性分析2005年3月至2013年3月收治的43例肢体军训伤后继发动脉血栓形成患者应用CDT治疗的临床资料。根据Rutherford分级：Ⅰ级1例，Ⅱa级23例，Ⅱb级15例，Ⅲ级4例。单纯应用CDT 22例，CDT+腔内球囊扩张成形（PTA）17例，CDT+PTA+支架植入4例。结果本组导管溶栓时间为1~7天，平均（3±2）天。治愈32例（74.4%），Ⅰ级1例，Ⅱa级21例，Ⅱb级9例，Ⅲ级1例；其中单纯CDT 22例，CDT+PTA 6例，CDT+PTA+支架植入4例。有效11例（25.6%），Ⅱa级2例，Ⅱb级6例，Ⅲ级3例；均施行CDT+PTA治疗。2例（4.7%）溶栓过程中发生二次栓塞予调整导管位置后继续溶栓，5例（11.6%）溶栓过程中发生小腿骨筋膜室综合征行骨筋膜室切开减压术，均保趾、保肢成功。43例均获得随访，随访时间12~108个月，平均（48±19）个月。患者均无症状加重或复发。结论 CDT治疗四肢外伤后继发动脉血栓形成是一种安全、有效、微创的方法。%Objective To evaluate the effect of catheter-directed thrombolysis(CDT)in the treatment of arterial thrombosis of extremities caused by military training injuries. Methods From Mar. 2005 to Mar. 2013,the clinical data of 43 patients(43 limbs)with arterial thrombosis of extremities caused by military training injuries treated by CDT were analyzed retrospectively. According to Rutherford Criteria , there were GradeⅠ1 cases,Grade Ⅱa 23 cases,Grade Ⅱb 15 cases,Grade Ⅲ4 cases. All of the cases underwent CDT with different procedures, including only CDT(22 cases), CDT combined with percutaneous transluminal angioplasty(PTA)(17 cases), CDT combined with PTA and stent implantation(4 cases). Results The CDT period was 1~7 days with a mean time of (3±2)days. Upon the results of angiography and following-up,32 cases(74.4%)were cured by only CDT(22 cases), CDT+PTA(6 cases)and CDT+PTA+stent implantation(4 cases), including GradeⅠ1 cases,GradeⅡa 21 cases,GradeⅡb 9 cases, GradeⅢ1 case. Eleven cases(25.6%)received effective results treated by CDT+PTA, including GradeⅡa 2 cases,GradeⅡb 6 cases,GradeⅢ3 cases. Secondary thrombosis occurred in 2 cases(4.7%)during the CDT, and thrombolysis continued after moving the catheter. Five cases(11.6%)underwent open decompression of compartment because of osteofascial compartment syndrome during the CDT and the extremities were saved. All cases(100.0%)were followed up with a mean time of (48±19) months(range,12~108 months), and no symptoms worsened and no recurrencde occurred. Conclusion CDT is a safe, effective and minimally invasive treatment for arterial thrombosis of extremities caused by military training injuries.