Savolaine E R, Ebraheim N A, Stitgen S, Jackson W T
Department of Radiology, Medical College of Ohio, Toledo 43699.
Clin Orthop Relat Res. 1991 Nov(272):136-40.
A 34-year-old man was injured in a motorcycle accident and suffered both aortic rupture and thoracic spinal fracture, complicated by an underlying undetected ankylosing spondylitis. The latter disease can affect the integrity of vascular and spinal structure. Aortography is recommended as a high priority for the patient in an unstable cardiovascular condition requiring a definitive diagnosis. Aortic rupture and thoracic spine fracture may occur from high energy deceleration trauma. Motor vehicle passenger and pedestrian injuries are most commonly involved, although airline accidents and high falls also generate some cases. Mediastinal widening, displacement of esophagus and trachea, apical dissection of blood, and, especially, paravertebral pleural space widening are common to both injuries. Whereas most mediastinal hematomas are nonaortic in origin, a combined injury must be considered because clinical features may also overlap. These include hypotension (hypovolemic or spinal shock), paraplegia, and severe back pain. In light of the high mortality and time constraints associated with aortic rupture, immediate diagnostic resolution is necessary for appropriate management and priority of investigation.
一名34岁男性在摩托车事故中受伤，同时发生主动脉破裂和胸椎骨折，并伴有潜在未被发现的强直性脊柱炎。后一种疾病会影响血管和脊柱结构的完整性。对于处于不稳定心血管状况且需要明确诊断的患者，建议优先进行主动脉造影。主动脉破裂和胸椎骨折可能由高能量减速创伤引起。机动车乘客和行人受伤最为常见，不过航空事故和高处坠落也会导致一些病例。纵隔增宽、食管和气管移位、血液向心尖部剥离，尤其是椎旁胸膜腔增宽在这两种损伤中都很常见。虽然大多数纵隔血肿并非源于主动脉，但必须考虑合并损伤，因为临床特征也可能重叠。这些包括低血压（低血容量性或脊髓休克）、截瘫和严重背痛。鉴于主动脉破裂相关的高死亡率和时间限制，为了进行适当的管理和确定检查优先级，必须立即做出诊断。
