Kim Hak Sun, Chong Hyon Su, Nanda Ankur, Park Jin Oh, Moon Seong Hwan, Lee Hwan Mo, Kim Ho Joong, Park Chun Kun, Park Ye Soo, Lee Suk Ha, Moon Eun Su
Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea.
J Spinal Disord Tech. 2010 Aug;23(6):418-24. doi: 10.1097/BSD.0b013e3181b63f33.
A retrospective outcomes study.
To stress on the importance of early diagnosis with the help of angiography and proper treatment of vascular injuries occurring during thoracolumbar surgeries and to report our results.
Vascular injury is a rare but dangerous complication that can develop during thoracolumbar surgeries and if not treated properly then it can lead to severe complications including the death of the patient.
The patients included in this study were the ones who were suspected to have a possible vascular injury after a thoracolumbar surgery. Contrast enhanced computed tomography was performed for patients having clinical signs suggesting vascular injury. Among these patients, who were suspected to have active bleeding and major vessel injury on computed tomography were further subjected to angiography.
Of the 10 cases included in the study, vascular injury was identified to be arterial in origin in 8 cases and venous in 3 cases. Among the 8 cases of identified arterial injury, angiography was performed in 4 cases, of which 3 were found to have active bleeding and were subjected to immediate intervention. Of the 4 cases in which angiography was not performed, 3 of them expired at variable postoperative periods. Complications developed in total 5 cases including 3 cases of mortality, 1 case of infection, and 1 case of cauda equina syndrome.
The vascular injuries during thoracolumbar spinal surgeries need immediate and aggressive treatment. In arterial injuries, we can prevent serious consequences by subjecting the patient to an angiography as early as possible followed by a therapeutic embolization. In contrast, for venous injuries if hemostasis has been confirmed, then an immediate intervention may not be always required.
一项回顾性结果研究。
强调在胸腰椎手术中借助血管造影进行早期诊断以及对血管损伤进行恰当治疗的重要性，并报告我们的结果。
血管损伤是一种罕见但危险的并发症，可在胸腰椎手术期间发生，若治疗不当可导致包括患者死亡在内的严重并发症。
本研究纳入的患者是那些在胸腰椎手术后被怀疑可能有血管损伤的患者。对有提示血管损伤临床体征的患者进行增强计算机断层扫描。在这些患者中，计算机断层扫描怀疑有活动性出血和大血管损伤的患者进一步接受血管造影。
在该研究纳入的10例病例中，确定血管损伤起源于动脉的有8例，起源于静脉的有3例。在8例已确定的动脉损伤病例中，4例进行了血管造影，其中3例发现有活动性出血并立即接受了干预。在未进行血管造影的4例病例中，3例在术后不同时期死亡。总共发生并发症5例，包括3例死亡、1例感染和1例马尾综合征。
胸腰椎脊柱手术期间的血管损伤需要立即积极治疗。对于动脉损伤，我们可以通过尽早让患者接受血管造影并随后进行治疗性栓塞来预防严重后果。相比之下，对于静脉损伤，如果已确认止血，则不一定总是需要立即干预。
