V-Y推进结合踇长屈肌腱转位修复KuwadⅢ型慢性跟腱损伤的疗效观察要点

V-Y推进结合踇长屈肌腱转位修复KuwadⅢ型慢性跟腱损伤的疗效观察沈国栋㊀朱永展∗㊀吴峰㊀彭智浩㊀邹运璇㊀张宏宁㊀李雪㊀杨康勇ʌ摘要ɔ㊀目的㊀探讨V-Y推进结合踇长屈肌腱转位修复KuwadⅢ型慢性跟腱损伤的手术技巧和临床疗效㊂方法㊀选择2012年2月-2014年2月收治的26例慢性跟腱断裂患者,其中男20例,女6例;年龄18 ~65岁,平均34.6岁,术中跟腱清创后腱缺损为3~5cm㊂采用有限切开V-Y推进结合踇长屈肌腱转位进行治疗,记录损伤愈合时间及相关并发症,并比较术前与末次随访时美国骨科足踝外科协会后足评分㊁疼痛视觉模拟评分量表及Leppilahti跟腱修复评定标准评分,采用配对样本t检验㊂结果㊀21例患者术后获12 ~26个月(平均16.4个月)门诊随访,5例失访㊂患者切口均一期愈合,无感染㊁神经损伤及跟腱再断等并发症发生㊂术后MRI示跟腱愈合时间平均为12周,挤压螺钉骨化时间平均为18个月㊂末次随访时,21例患者美国骨科足踝外科协会中足评分由术前平均(52.6ʃ15.4)分上升至(96.8ʃ2.5)分;疼痛视觉模拟评分量表评分由术前平均(5.71ʃ1.56)分降低至(1.24ʃ0.44)分;依据Leppilahti跟腱修复评分从术前(68.56ʃ7.43)分提高到术后(92.58ʃ5.1)分㊂以上项目术前与末次随访时比较差异均有统计学意义(均P<0.05)㊂结论㊀V-Y推进结合踇长屈肌腱转位治疗慢性跟腱损伤较适合断端缺损在3~5cm间的患者,该方法操作简单㊁并发症少,是一种安全㊁有效的手术选择㊂ʌ关键词ɔ㊀慢性跟腱损伤;V-Y推进;肌腱转位;骨折愈合;治疗结果;手术后并发症基金项目:广东省佛山市卫生局项目(2015267)The clinical effects of V-Y advancement and flexor hallucis longus tendon transfer in the treatment of KuwadⅢtype chronic achilles tendon injury㊀Shen Guodong,Zhu Yongzhan∗,Wu Feng,Peng Zhihao,Zou Yunxuan, Zhang Hongning,Li Xue,Yang Kangyong.Department of Orthopaedics,Foshan Hospital of Traditional Chinese Medicine,Foshan528000,ChinaCorresponding author:Zhu Yongzhan,Email:ao009@ʌAbstractɔ㊀Objective㊀To investigate the operative technique and clinical effects of V-Y advancement and flexor hallucis longus tendon transfer in the treatment of chronic achilles tendon ruptures.Methods㊀Twenty-six patients with chronic achilles tendon ruptures treated between February2012and February2013were involved in the study, including20males and6females,at age of22to58years(average33.6years).The length of achilles tendon defect after intra-operative debridement is ranging from3to5cm.Limited open repair of chronic achilles tendon ruptures using V-Y advancement and flexor hallucis longus tendon transfer were performed and the healing time and complications were recorded.The pre-and postoperative American Orthopaedic Foot and Ankle Society ankle-hindfoot scores,visual analog scale scores for pain and Leppilahti achilles tendon repair score were compared. Results㊀Twenty-one patients were followed up for12to26months(average16.4months)and five cases were lost.All incisions were in primary healing,without any complications such as infection,nerve injury and secondary rupture.The average healing time of achilles tendons was12weeks according to MRI imaging and the average ossification time of interference screws was18months.At latest follow up,the American Orthopaedic Foot and Ankle Society ankle-hindfoot scores improved from(52.6ʃ15.4)preoperatively to(96.8ʃ2.5).Similarly, preoperative Visual analog scale score was(5.71ʃ1.56),and mean postoperative Visual analog scale was(1.24ʃ0.44).Besides,Leppilahti achilles tendon repair score was improved from(68.56ʃ7.43)to(92.58ʃ5.1). There were significant differences between the pre-and postoperative scores in all the three evaluations(P< DOI:10.3760/cma.j.issn.1673-4203.2016.11.008作者单位:528000佛山,广东省佛山市中医院足踝外科万方数据通信作者:朱永展,Email:ao009@0.05).Conclusions㊀Limited open repair of chronic achilles tendon ruptures using V-Y advancement and flexor hallucis longus tendon transfer may be a good option for a defect gap ranging3to5cm.It is a safe and effective surgery due to its simpleness and less complications.ʌKey wordsɔ㊀Chronic achilles tendon injury;V-Y advancement;Tendon transfer;Fracture healing;㊀Treatment outcome;Postoperative complications㊀㊀Fund program:Subject of Foshan Municipal Health Bureau(2015267)㊀㊀急性跟腱断裂若因各种原因未得到及时恰当治疗,在4~6周后将发展为慢性跟腱断裂[1],其中KuwadⅢ型慢性跟腱损伤(清创后跟腱两断端缺损在3~5cm)最为常见,大多需手术治疗恢复足踝功能[2]㊂其手术方法报道甚多,但目前尚无统一的手术标准[3]㊂笔者2012年2月-2014年2月采用切开V-Y推进结合踇长屈肌腱转位治疗陈旧慢性跟腱断裂,获得了较好的疗效,现报道如下㊂1㊀临床资料与方法1.1㊀一般资料本组26例(26足),男20例,女6例;年龄18~ 65岁,平均34.6岁;均为单侧损伤,左足9例,右足17例;受伤至本次手术时间为1.8~11个月,平均3.6个月㊂致伤原因:运动伤16例,撞击伤7例,割裂伤3例㊂造成陈旧性损伤的原因为:漏诊㊁误诊18例,诊断明确保守治疗6例,断裂修补术后再次摔伤2例㊂与健侧对照,术前患者患侧跟腱均存在不同程度的行走或提踵无力,跟腱区域均可见或触及凹陷,均沿跟腱走行区域有压痛;Thompson试验阳性18例,可疑阳性3例,阴性5例㊂踝关节跖屈力量较健侧明显减弱或无跖屈㊂术前MRI示跟腱断裂间隙为3.2~5.4cm㊂损伤根据Kuwad分型均为Ⅲ型,所有患踝术前均摄负重位正位㊁侧位X线片(测量Kagerᶄs角),同时超声及MRI检查,并结合病史及受伤机制,评估跟腱部软组织情况,最终制定手术方案㊂1.2㊀手术方法全麻或者硬膜外麻醉后,患者大腿绑止血带后俯卧位,患肢消毒铺巾,驱血后止血带充气㊂切口以跟腱断裂凹陷处为中心切开,远端弧向内侧,术中根据缺损长度确定向近端延长皮肤切口,切口内避免损伤腓肠神经,全层切开皮肤至腱旁膜,暴露跟腱断裂区后,切除断端瘢痕组织及失活的跟腱组织,屈膝30ʎ㊁足跖屈20ʎ让小腿达到健侧休息位张力后测量断端缺损距离,于跟腱腱腹联合处作倒转的 V 形切口,保留肌腱下方肌肉纤维的完整性以及和近端肌肉的连续性,使倒转 V 形的尖端位于腱-腹交界处最近端的中线上, V 的双臂各自离开跟腱的外侧缘及内侧缘,牵拉跟腱近端缝线,持续牵引直至跟腱断端能相互靠拢,远端切口探查踇长屈肌腱,通过牵拉肌腱发现踇趾屈曲可辨认踇长屈肌腱,沿着该肌腱打开其腱鞘时要沿着肌腱外侧进行分离,避免损伤胫后神经及血管,将踝关节及踇趾极度屈曲,将踇长屈肌腱牵拉至最大幅度后,在最远端将其切断,远端残端无需处理,然后测量近端肌腱直径,于跟骨结节后侧㊁跟腱止点前方钻一个与肌腱直径相符的骨隧道,在踇长屈肌腱远端利用Krackow 缝合法编织后留有部分尾线,并用套线器将其拉进隧道,尾部缝线从足底拉出,牵拉缝线使肌腱在骨隧道内获得合适张力,保持足轻微跖屈位,使用同骨隧道大小相同的施乐辉挤压螺钉(Depuy公司,美国)固定肌腱,从而完成踇长屈肌腱转位㊂之后再进行跟腱断端缝合,采用非可吸收线应用Krackow缝合法进行缝合跟腱,修复跟腱上的 V 形切口,形成倒转 Y 字,用可吸收线将部分踇长屈肌肌腹与跟腱背面缝合,可以给断端提供血管床,促进跟腱愈合,之后用可吸收线缝合腱旁膜,放置引流后逐层关闭切口㊂敷料包扎后利用石膏或支具将踝关节固定于跖屈休息位㊂具体操作以本组1例42岁的男性患者,右侧陈旧性跟腱断裂,打篮球拉伤足跟部乏力3个月为例(插页二,图1㊁图2)㊂1.3㊀术后处理和疗效评估术后常规放置负压引流48h,并予静脉药物抗感染㊁消肿治疗㊂踝关节轻度跖屈休息位石膏托固定2周后,使用跟腱鞋开始踝关节背伸功能锻炼,术后6周严格限制患者非负重,6周后跟腱鞋保护下允许患肢逐步负重,该鞋内垫3个楔形鞋垫,每2周移除1个鞋垫,逐步开始功能锻炼㊂术后12周去除跟腱鞋后行走,并开始进行跟腱主动伸展㊁跟腱力量加强及小腿训练,并可以在舒适情况下开始日常活动,术后6个月内需避免突然加速或停止㊁跳跃等动作㊂术后定期门诊随访3个月㊁6个月㊁12个月复查跟腱MRI㊂根据美国骨科足踝外科协会(American Orthopedic Foot and Ankle Society,AOFAS)踝-后足评分㊁Leppilahti等[3]跟腱修复评分系统及疼痛视觉模拟评分量表(Visual analogue scale,VAS)对患肢后足功能恢复情况进行评估,并记录相关并发症㊂1.4㊀统计学分析应用SPSS19.0统计学软件,计量资料以(ʏxʃs)万方数据表示㊂患者术前与末次随访时的AOFAS评分㊁Leppilahti评分及VAS评分采用配对样本t检验对患者术前与术后评分进行比较,P<0.05为差异具有统计学意义㊂2㊀结果21例患者术后获平均16.4个月(12~30个月)随访,5例失访㊂此21患者切口均一期愈合,无感染㊁皮肤坏死㊁跟腱再发断裂㊁神经损伤等并发症发生㊂所有患者跟腱后方外形平坦,未见凹陷,第2年随访时21例患者中17例可以连续做10次以上单脚提踵㊂末次随访时,21例患者AOFAS后足评分由术前平均(52.6ʃ15.4)分(30~55分)上升至(96.8ʃ2.5)分(93~98分),差异有统计学意义(t=10. 590,P<0.001);依据Leppilahti跟腱修复评分从术前(68.56ʃ7.43)分提高到术后(92.58ʃ5.1)分(P<0.05)㊂无一例发生腓肠神经及胫神经损伤㊁跖部痛性瘢痕㊁足底内外侧神经损伤㊂VAS评分由术前(5.71ʃ1.56)(2~6分)分降低至(1.24ʃ0.44)分(0~2分),差异具有统计学意义(P<0.05)㊂同时未见内固定失效㊁踝关节创伤性关节炎等相关并发症㊂3㊀讨论3.1㊀慢性陈旧跟腱损伤的形成原因有文献报道急性跟腱断裂漏诊率为20%~ 30%,4~6周后将发展为慢性跟腱损伤[4]㊂本组26例患者主要由漏诊或误诊㊁手术方式及术后锻炼方法不当三大原因所致㊂跟腱为人体最强的肌腱,也是踝关节跖屈的主要力量,跟腱断裂导致腓肠肌-比目鱼肌 跟腱的屈踝机制中断,由于胫后肌㊁踇长屈肌及趾长屈肌的协同作用,踝足跖屈活动仍有保留,跟腱断裂往往只表现为跖屈力量减弱,因此很多患者往往被认为仅是单纯的扭挫伤,导致漏诊㊂其次,接诊医师对闭合性断裂损伤未认真进行提踵及Thompson试验,早期误诊为软组织损伤,未作规范治疗,本组出现12例㊂对开放性跟腱损伤时,伤口内未做探查便予清创缝合,后期患者因跟腱部疼痛减轻,断端被瘢痕充填,凹陷触摸不明显,Thompson试验阴性,容易出现反复漏诊,本组出现4例㊂因此,对跟腱断裂损伤的患者,无论损伤性质新鲜陈旧与否,要求接诊医师时刻具备高度责任心,对于怀疑跟腱断裂的患者,可行具体的专科检查试验帮助诊断㊂如Thompson试验㊁Matles试验㊁0 Brien针试验和Copeland试验,如果以上试验中有2项为阳性,则确诊存在跟腱断裂[5-6]㊂另外对于跟腱断裂的患者,高分辨率B超可显示肌腱的不连续性,MRI则更加能显示完全断裂的肌腱断端的详细情况㊂此外,部分患者虽然采用了手术治疗,但跟腱修复术后张力过大㊁强度不够,术中对跟腱供血的过度干扰及术后不正确的功能锻炼(如过早下地负重),术后石膏固定时间过短或再次外伤,也会造成慢性跟腱断裂㊂因此,早期诊断㊁早期精细修复及正规康复锻炼是目前治疗急性跟腱断裂的主要原则,可以有效减少后遗症和降低致残率[7]㊂3.2㊀治疗原则及手术方式选择手术修复治疗跟腱断裂,特别是慢性跟腱断裂患者,已经在临床医师中取得了广泛的共识㊂手术目的是重建跟腱的腱性结构完整,恢复提踵和跖屈蹬力㊂而手术方法也多种多样,对于缺损<2cm者,可行端-端缝合修补㊂缺损>3cm者,大多数难以用单纯端-端缝合完成修补,常见有 V-Y 推进㊁踝周自体肌腱移位修复(如踇长屈肌腱[8]㊁腓骨长㊁短肌腱㊁趾屈肌腱等)㊁游离组织转位(自体游离肌腱㊁肌腱骨瓣㊁同种异体移植物)及各种人工合成材料[9]㊂本组患者术中清创后跟腱两断端缺损均在3~5cm,单纯采用 V-Y 推进可以保证端对端的吻合,但腓肠肌筋膜广泛的切取及与肌纤维的锐性分离后,易出现连续性不牢靠㊁瘢痕粘连影响踝关节功能等并发症㊂踇长屈肌腱具有韧性好㊁肌力强㊁收缩力轴与跟腱类似等优点,因此常作为修复陈旧慢性跟腱损伤的供体,既能用于修复短节段也能用于长节段的跟腱缺损,常作为跟腱周围肌腱移植重建跟腱的首选[10],但其也有肌腱单束编织重建跟腱时,因腱体单薄,强度相对不足,而采用双束重建时,对于部分缺损较多的患者则长度不够等缺点,而切取足够长踇长屈肌腱易引起术后踇趾跖屈肌力的明显减弱㊂Wilcox等[11]报道采用双切口获取踇长屈肌腱时还需在足内侧缘另作一切口找出肌腱远端切断,该方法花费时间较长,而且容易损伤足底内侧神经㊂本研究中采用 V-Y 推进与踇长屈肌腱转位联合术式并予适当改良,术中跟腱近端小切口行 V-Y 推进达到端-端吻合,同时保护腓肠神经,通过远端切口行跟腱清创时,在同一切口下找出踇长屈肌腱,于足底Henry结节近侧取踇长屈肌,尽管切取腱性长度比采用双切口时要短,可采用生物型可吸收挤压螺钉固定于跟骨隧道内,获得与跟腱相同做功力臂,之后将踇长屈肌肌腹与跟腱延长筋膜瓣进行边-边缝合,能增加踝关节跖屈强度及恢复踝足的推动力㊂在本研究中所有病例不涉及足底切口,可完全避免损伤足底内侧神经等手术风险㊂Elias等[12]应用V-Y延长术结合踇长屈肌腱转位加强修补15例跟腱断裂,其中跟腱最小分离5cm,同健侧相比,在Cybex 试验中,60ʎ/s跖屈扭力降低22.3%㊁120ʎ/s跖屈扭万方数据力降低13.5%,患者平均踝关节活动度丢失5ʎ, AOFAS后足评分从术前平均58.4分提高至术后94.1分㊂由此可见联合术式的应用能明显改善患足跖屈力量,能获得较高评分㊂在本组病例中,所有研究对象的跟腱断端缺损均<5cm,而 V-Y 成形术向下推移一般不能>6cm,否则将影响重建跟腱的生物力学强度[11]㊂张海波和王义生[15]应用 V-Y 延长治疗KuwadⅢ型陈旧跟腱断裂取得了100%的优良率㊂由于使用了有限切开技术,减轻了对跟腱周围血运破坏,本组病例术后跟腱力学强度应高于Elias等的报道,本组随访也证明,患者术后平均AOFAS评分高达(96.43ʃ2.84)分,患者满意度高,证明该术式能取得更为满意的疗效㊂3.3㊀术后并发症及注意事项跟腱周围手术最常见的并发症之一就是切口的愈合问题,这与缝合时皮肤张力过大及切口过长导致的皮肤血供差均有一定关系㊂本研究中测量断端缺损距离后采用有限切开技术,远近端切口之间皮肤及腱旁膜仍然完整,大大减少血供破坏,减少了术后组织粘连及切口并发症㊂联合术式完成后用可吸收线将踇长屈肌肌腹与跟腱背面缝合,可以给断端提供血管床,促进跟腱愈合㊂从理论上说,FHL转位后会引起踇趾跖屈力量减弱㊁踇趾足底应力减少,本研究中踇长屈肌腱切取在Henry结节近侧,因Henry结节处有联合腱与趾长屈肌腱连接,术后踇趾的屈曲可通过趾长屈肌腱大部分代偿,故能使第一足趾屈曲力量得到部分保存,国外亦有相关研究表明相应的生物力学变化并未造成足部功能的减弱[13]㊂Maffullin等[14]认为行单纯 V-Y 推进会发生小腿三头肌无力㊁踝关节功能障碍和再次断裂等并发症㊂本组观察所有患者术后2年随访患侧小腿周径基本与健侧等同,笔者虽未对踝关节跖屈肌力的改变进行量化研究,但从患者能连续完成单足提踵试验㊁完成单腿跳跃等动作来看,患者小腿三头肌肌力得到了恢复㊂而且对患者术后进行基于MRI 检查的随访研究发现,踇长屈肌肌腹不但未出现变性,反而在85%的患者中有增粗现象,因此采用 V-Y 成形术后不但保留了小腿三头肌,再利用踇长屈肌腱加强后,进一步增强了踝关节跖屈肌力,提高了治疗效果㊂4㊀结果本组观察为回顾性分析, V-Y 推进结合踇长屈肌腱转位是治疗断端缺损为3~5cm的慢性跟腱损伤的有效治疗手段,有限切开后损伤减小,进一步保护跟腱周围血供,并发症少,同时恢复其连续性和长度 张力关系,能获得确凿的术后功能评分,患者满意度极高,但有必要对患者进行长期随访来观察该术式对患者的影响,同时应与其他术式对比来进一步评估疗效㊂参考文献[1]㊀Longo UG,Lamberti A,Maffulli N,et al.Tendon augmentationgrafts:a systematic review[J].Br Med Bull,2010,94(1):165-188.DOI:10.1093/bmb/ldp051.[2]㊀Wang CC,Lin LC,Hsu CK,et al.Anatomic reconstruction ofneglected Achilles tendon rupture with autogenous peroneal longustendon by EndoButton fixation[J].Trauma,2009,67(5):1109-1112.DOI:10.1097/TA.0b013e3181a73f02.[3]㊀Leppilahti J,Forsman K,Puranen J,et al.Outcome andprognostic factors of achilles rupture repair using a new scoringmethod[J].Clin Orthop Relat Res,1998,346(346):152-161.DOI:10.1097/00003086-19980100000022.[4]㊀Wong J,Barrass V,Maffulli N.Quantitative review of operative andnonoperative management of achilles tendon ruptures[J].AmSports Med,2002,30(4):565-575.DOI:10.1177/03635465020300041701.[5]㊀Maffuli N,Ajis A.Management of chronic ruptures of theachillestendon[J].J Bone Joint Surg(Am),2008,90-A(6):1348-1360.DOI:10.2106/JBJS.G.01241.[6]㊀Sharma P,Maffulli N.Tendon injury and tendinopathy:healing andrepair[J].J Bone Joint Surg,2005,87(1):187-203.DOI:10.2106/JBJS.D.01850.[7]㊀Hahn F,Meyer P,Maiwald C,et al.Vienne P.Treatment ofchronic achillestendinopathy and ruptures with flexor hallucistendon transfer:clinical outcome and MRI findings[J].Foot AnkleInt,2008,29(8):794-802.DOI:10.3113/FAI.2008.0794.[8]㊀Wegrzyn J,Luciani JF,Philippot R,et al.Chronic Achillestendon rupture reconstruction using a modified flexor hallucis longustransfer[J].Int Orthop,2010,34(8):1187-1192.DOI:10.1007/s00264-009-0859-1.[9]㊀Choksey A,Soonawalla D,Murray J.Repair of neglected Achillestendon ruptures with Marlex mesh[J].Injury,1996,27(3):215-217.[10]㊀Myerson MS.Achilles tendon ruptures[J].Instr Course Lect,2014,13:153-156.[11]㊀Wilcox DK,Bohay DR,Anderson JG.Treatment of chronicAchilles tendon disorders with flexor hallucis longus tendontransfer/augmentation[J].Foot Ankle int,2000,21(12):1004-1010.[12]㊀Elias I,Besser M,Nazarian LN,et al.Reconstruction for missedor neglected Achilles tendon rupture with V-Y lengthening andflexor hallucis longus tendon transfer through one incision[J].FootAnkle Int,2007,28(12):1238-1248.DOI:10.3113/FAI.2007.1238.[13]㊀Richardson DR,Willem J,Cohen BE.Evauation of the halluxmorbidity of single-incision flexor halluces longus tendon transfer[J].Foot Ankle Int,2009,30(7):627-630.DOI:10.3113/FAI.2009.0627.万方数据[14]㊀Maffulli N,Ajis A.ManagemenI of chronic ruptures of the AchiIlestendon[J].J Bone Joint Surg Am,2008,90(6):1348-1360.DOI:10.2106/JBJS.G.01241.[15]㊀张海波,王义生.V-Y肌腱瓣修复治疗KuwadeⅢ型陈旧性跟腱断裂的疗效观察[J].中国矫形外科杂志,2011,19(20): 1743-1745.DOI:10.3977/j.issn.1005-8478.2011.20.21.(收稿日期:2016-09-16)升主动脉至胸降主动脉人工血管转流在主动脉缩窄外科治疗中的应用章旭㊀张超纪㊀刘兴荣㊀李晓凤㊀苗齐∗ʌ摘要ɔ㊀目的㊀分析总结使用升主动脉至胸降主动脉人工血管转流术治疗成人型主动脉缩窄10例临床病例资料,探讨升主动脉至胸降主动脉人工血管转流术在临床中治疗主动脉缩窄的意义㊂方法㊀中国医学科学院㊁北京协和医院心脏外科2006年1月-2015年12月共收治成人主动脉缩窄患者10例,其中男性患者7例,女性患者3例,年龄14~35岁,中位年龄27岁,其中1例合并主动脉瓣二瓣畸形及主动脉根部瘤样扩张,余均为单纯主动脉缩窄㊂10例患者静息情况下测量上下肢压差均大于20mmHg(1mmHg=0.133kPa),术前评估无明确手术禁忌㊂10例均在体外循环下行升主动脉至胸降主动脉人工血管转流术,合并主动脉瓣二瓣畸形及主动脉根部扩张的患者,同时行Bentall术㊂结果㊀无围术期死亡及大出血㊁脊髓缺血性损害等严重并发症,嘱托患者出院后3~6个月门诊复查,复测上下肢压差均小于20mmHg,CTA 结果提示未见动脉瘤㊁人工血管血栓形成等表现㊂结论㊀利用人工血管从升主动脉转流至降主动脉是治疗胸主动脉缩窄的有效方法㊂ʌ关键词ɔ㊀主动脉缩窄;人工血管转流术;心血管畸形;外科手术Ascending to descending aorta extraanatomic bypass for coarctation of aorta㊀Zhang Xu,Zhang Chaoji,Liu Xingrong,Li Xiaofeng,Miao Qi. Cardiac Surgery Department,Chinese Acdemy of Medical Sciences,Peking Union Medical Hospital,Beijing100032,China Corresponding author:Miao Qi,Email:miaoqipumc@ʌAbstractɔ㊀Objective㊀To summarize the treatment of10aortic coarctation cases,who receive the surgery from ascending aorta to thoracic descending aorta with the prosthetic graft,discuss the valuable and appliable of this method.Methods㊀Cardiac surgery,Chinese Acdemy of Medical Sciences,Peking Union Medical College Hospital department treated10patients who got the aortic coarctation from Jan.2006to Dec.2015Seven male patients and 3cases of female patients consist of the sample,aged from14to35years old,the median age was27.One cases consolidated aortic valve deformity and aortic root expansion,the others were simple aortic coarctation.Their upper limbs blood pressure was20mmHg higher compared with the low limb.Meanwhile,there was no sign of surgery contraindication.Ten cases received this operation under cardiopulmonary bypass situation.And the patient who consolidate aortic valve deformity and aortic root expansion receive the Bentall surgery at the same time.Results㊀There was no death during perioperative time,no spinal cord ischemic and other serious complications.Those patients went back to outpatient department after discharging from hospital3to6months.The differential pressure between upperlimbs and low limbs were less than20mmHg,and the CTA results indicated no aneurysms. Conclusion㊀Using artificial blood vessels to make a graft from the ascending aorta to the descending aorta is an effective method for treatment of thoracic aorta.ʌKey wordsɔ㊀Aortic coarctation;Bypass;Cardiovascular abnormalities;Surgical procedures,operative DOI:10.3760/cma.j.issn.1673-4203.2016.11.009作者单位:100032北京,中国医学科学院㊁北京协和医院心脏外科通信作者:苗齐,Email:miaoqipumc@万方数据。