Geervliet Pieter C, van Royen Barend J, Vonk Noordegraaf Anton, Kranendonk Steef E, David Eric F, Paul Marinus A
Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Spine (Phila Pa 1976). 2007 Nov 15;32(24):E730-3. doi: 10.1097/BRS.0b013e31815a5a63.
Case report.
Describes a case report of a 16-year-old woman treated for adolescent idiopathic scoliosis (AIS) by anterior spinal fusion and instrumentation, who developed a spontaneous massive intrathoracic bleeding 10 months after surgery.
Hemothorax (HT) is a known rare postoperative complication of anterior spinal scoliosis surgery. However, spontaneous HT has never been described as a late complication, in relationship to diaphragm movement over the anterior instrumentation material.
Retrospective case report.
A 16-year-old woman with Lenke type I AIS underwent a successful anterior spinal fusion with instrumentation. After surgery, there were no complications, however, she experienced a distressing grating sensation while breathing. Ten months after surgery, the patient developed a spontaneous HT that needed emergency surgery. Erosion of a small artery in the scar tissue around the most caudal screw of the instrumentation proved to be the cause of the late HT. Subsequent dynamic magnetic resonance imaging showed the relationship between the moving diaphragmatic muscles and the most caudal screws of instrumentation material during breathing. Sixteen months after the initial surgery, the anterior instrumentation was removed.
Late spontaneous HT in patients with anterior fusion and instrumentation for AIS is a rare but life-threatening complication.
病例报告。
描述一例16岁女性青少年特发性脊柱侧凸（AIS）患者，接受前路脊柱融合内固定术后10个月发生自发性大量胸腔内出血的病例报告。
血胸（HT）是前路脊柱侧凸手术已知的罕见术后并发症。然而，自发性血胸从未被描述为与前路内固定材料上方膈肌运动相关的晚期并发症。
回顾性病例报告。
一名16岁Lenke I型AIS女性患者成功接受了前路脊柱融合内固定术。术后无并发症，但她在呼吸时感到令人痛苦的摩擦感。术后10个月，患者发生自发性血胸，需要紧急手术。器械最尾端螺钉周围瘢痕组织中的一条小动脉侵蚀被证明是晚期血胸的原因。随后的动态磁共振成像显示了呼吸过程中运动的膈肌与器械材料最尾端螺钉之间的关系。初次手术后16个月，取出前路内固定物。
AIS前路融合内固定患者发生晚期自发性血胸是一种罕见但危及生命的并发症。
