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目的观察长球囊血管腔内成形术(percutaneous transluminal angioplasty,PTA)联合丹参注射液,腔内加压注射治疗糖尿病膝下血管病变的疗效。方法 19例糖尿病患者共23条膝下动脉硬化闭塞肢体,首先采用长球囊开通狭窄、闭塞的血管,再联合丹参注射液腔内加压注射治疗。术后观察踝/肱指数、通畅率、溃疡愈合时间及临床症状的改善。结果 21条患肢得到成功治疗,技术成功率91.3%(21/23)。踝/肱指数(ankle brachial index,ABI)由术前的0.31±0.14上升为术后的0.71±0.18,与术前比较差异有统计学意义(P<0.05)。术后随访3～10个月,13条患肢(61.9%)间歇性跛行、患肢静息痛等临床症状基本消失,足背或胫后动脉搏动恢复;8条(38.1%)患肢明显缓解。6条肢体术前伴足趾溃疡者,术后创面均愈合;1条足趾坏疽肢体清创换药23天后行截趾术,术后切口愈合良好。术后1、3、6个月通畅率分别为95.2%、85.7%、61.9%。结论腔内加压注射丹参注射液作为长球囊PTA微创治疗糖尿病合并膝下血管病变的补充,可促进动脉侧支血管生成,改善血供,改善微循环,促进糖尿病足溃疡面愈合,近期疗效好、通畅率高,值得推广。
Objective To observe the curative effect of percutaneous transluminal angioplasty (PTA) combined with Salvia miltiorrhiza injection and intracavitary pressure on the treatment of diabetic knee lesions. Methods A total of 23 patients with atherosclerosis of knee underwent occlusion in 19 diabetic patients. First, a long balloon was used to open stenosed and occluded blood vessels, and then combined with injection of Salvia miltiorrhiza intralesional injection. Postoperative ankle / brachial index, patency, ulcer healing time and improvement of clinical symptoms. Results 21 limbs were successfully treated, the technical success rate was 91.3% (21/23). The ankle / brachial index (ABI) increased from 0.31 ± 0.14 before operation to 0.71 ± 0.18 after operation, which was significantly different from that before operation (P <0.05). All cases were followed up for 3 to 10 months. The clinical symptoms such as intermittent claudication of 13 affected limbs (61.9%) and rest pain of limbs disappeared basically, and the pulse of dorsal or posterior tibial artery was recovered. The affected limbs of 8 (38.1%) were obvious ease. 6 limbs preoperative with toe ulcer, the wounds were healed after surgery; 1 toe gangrene limb debridement after 23 days of debridement surgery, incision healed well. Patency rates at 1, 3 and 6 months after operation were 95.2%, 85.7% and 61.9%, respectively. Conclusion The intra-articular injection of Salvia miltiorrhiza injection as a supplement to long-balloon PTA minimally invasive therapy for diabetic patients complicated with knee lacunar disease can promote arterial collateral vessels, improve blood supply, improve microcirculation and promote healing of diabetic foot ulcers, and short-term curative effect Well, patency rate, it is worth promoting.