Inaba K, Kirkpatrick A W, Finkelstein J, Murphy J, Brenneman F D, Boulanger B R, Girotti M
London Health Sciences Centre, Ont., London, Canada.
Injury. 2001 Apr;32(3):201-7. doi: 10.1016/s0020-1383(00)00203-5.
All patients with blunt abdominal aortic disruption (BAAD) in the trauma registries at the three Regional Trauma Centres were retrospectively reviewed over the last decade. From the 11465 trauma admissions ISS>16,194 sustained aortic injuries. Eight cases of BAAD were identified, six with concurrent thoracolumbar spine (TLS) fractures (mean ISS 42). Patients with BAAD and TLS were subject to a detailed analysis. Clinically, three injury types were seen, hemodynamically unstable (uncontained full thickness laceration), stable symptomatic (intimal dissection with occlusion), and stable asymptomatic (contained full thickness laceration or intimal dissection without occlusion). All spinal column fractures involved a distractive mechanism, one with both distractive and translational fracture components. We propose that a distractive force, applied to the aorta lying anterior to the anterior longitudinal ligament, results in an aortic injury spectrum ranging from an intimal tear to a full thickness laceration, as a related injury. Computed tomography (CT) was an important imaging modality in the stable asymptomatic patients. All intimal dissections without occlusion were managed non-operatively. With distractive TLS fractures, BAAD needs to be considered.
对过去十年间三个地区创伤中心创伤登记处中所有钝性腹主动脉破裂（BAAD）患者进行了回顾性研究。在11465例创伤入院患者中，损伤严重度评分（ISS）>16分，其中194例发生主动脉损伤。共识别出8例BAAD患者，6例合并胸腰椎骨折（TLS）（平均ISS为42分）。对BAAD合并TLS患者进行了详细分析。临床上可见三种损伤类型，血流动力学不稳定型（未包裹的全层撕裂）、稳定有症状型（内膜撕裂伴闭塞）和稳定无症状型（包裹的全层撕裂或内膜撕裂但未闭塞）。所有脊柱骨折均涉及牵张机制，其中1例同时存在牵张性和移位性骨折成分。我们提出，作用于位于前纵韧带前方的主动脉的牵张力会导致从内膜撕裂到全层撕裂的一系列主动脉损伤，作为一种相关损伤。计算机断层扫描（CT）对于稳定无症状患者是一种重要的影像学检查方法。所有未闭塞的内膜撕裂均采取非手术治疗。对于伴有牵张性TLS骨折的情况，需要考虑BAAD。
