Background
Tibial cortex transverse transport (TTT) surgery presents favorable outcomes for treating thromboangiitis obliterans (TAO). However, TTT is associated with complications and requires prolonged bed rest, impacting patients' quality of life. This study aimed to introduce iliac crest bone distraction (ICBD) surgery as a novel surgical approach to TAO clinical management by comparing ICBD's clinical outcomes with TTT's.
Methods
Between April and October 2023, 18 male patients meeting inclusion criteria were randomly assigned to the ICBD or TTT group. Pre- and postoperative changes in wound healing time, visual analog scale (VAS) pain scores, pain disappearance time, serum IL-6 levels, and intermittent lameness distance were evaluated. Infrared thermography assessed foot perfusion and temperature changes, while computed tomographic angiography (CTA) revealed lower limb vascular regeneration.
Results
During the 6-month follow-up period, no complications arose in either group. Successful ulcer healing similarly occurred in the 4 ICBD and 4 TTT patients with ulcers. Preoperative VAS scores were similar for ICBD and TTT (P = 0.612), with considerable improvements at one week postoperatively (P = 0.995). Disappearance time of rest pain was also similar for both groups (P = 0.537). Preoperative serum IL-6 levels were comparable (P = 0.842) but significantly decreased at one month postoperatively to similar levels for both groups (P = 0.539). Infrared thermography revealed postoperative improved thermal hotspot distribution. Six months after surgery, CTA showed an improved artery network of the lower limb. According to the Patwa and Krishnan grading system, six patients were "excellent" in the ICBD group one year after surgery and 7 in the TTT group, while 3 and 2 patients were "good", respectively.
Conclusions
Preliminary results demonstrate that ICBD's outcomes for TAO are similar to those of TTT but with fewer complications and a better quality of life. Therefore, we consider ICBD a promising surgical approach for treating TAO.
Trial registration
This study was registered with the Ethics Committee of the Affiliated Hospital of Zunyi Medical University (20230411) and at the Chinese Clinical Trial Registry (ChiCTR2300072418).
