Königshausen Matthias, Dudda Marcel, Merle Christian, Schildhauer Thomas Armin, Fehmer Tobias
Department of General and Trauma Surgery, BG Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Germany.
Orthopedics. 2012 Jun;35(6):e1000-4. doi: 10.3928/01477447-20120525-53.
This article describes the critical clinical sequelae of a patient with diffuse idiopathic skeletal hyperostosis who sustained an acute iatrogenic thoracic vertebral body fracture with subsequent spinal cord injury after a total hip replacement, with a final lethal course.A 57-year-old woman was referred to the authors' institution after undergoing a total hip replacement in the supine position for secondary osteoarthritis. Postoperatively, the patient had symptoms of an incomplete paraplegia. Computed tomography scan and magnetic resonance imaging revealed diffuse idiopathic skeletal hyperostosis and an acute unstable fracture of T11 with spinal contusion. A posterior spinal fusion of T10-L1 with laminectomy of T11 was performed immediately on admission. Postoperatively, no improvement of the neurological deficit was observed. After developing multiorgan failure while in intensive care, the patient died 2 months after the total hip replacement.The morphological and functional symptoms of diffuse idiopathic skeletal hyperostosis with the typical ossification of the longitudinal ligaments and the associated loss of bending forces of the spine were detected postoperatively. This severe case demonstrates that the surgeon must be alert to possible complications due to intraoperative maneuvers in patients with stiffened spinal disorders undergoing total hip replacement.
本文描述了一名弥漫性特发性骨肥厚患者在全髋关节置换术后发生急性医源性胸椎椎体骨折并继发脊髓损伤，最终导致致命结局的严重临床后果。一名57岁女性因继发性骨关节炎在仰卧位接受全髋关节置换术后被转诊至作者所在机构。术后，患者出现不完全截瘫症状。计算机断层扫描和磁共振成像显示弥漫性特发性骨肥厚以及T11急性不稳定骨折伴脊髓挫伤。入院后立即进行了T10-L1后路脊柱融合术并切除T11椎板。术后，神经功能缺损未见改善。在重症监护期间出现多器官功能衰竭后，患者在全髋关节置换术后2个月死亡。术后检测到弥漫性特发性骨肥厚的形态和功能症状，伴有典型的纵向韧带骨化以及相关的脊柱弯曲力丧失。这个严重病例表明，对于接受全髋关节置换术的脊柱僵硬疾病患者，外科医生必须警惕术中操作可能导致的并发症。
