Sasagawa Takeshi, Murakami Hideki, Maruhashi Yoshinobu, Segawa Takeshi, Yamamoto Daiki, Shimizu Shusuke, Morita Yasuhiko, Nakamura Takuya
Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, Kanazawa University, Kanazawa, Japan.
Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.
Asian Spine J. 2015 Oct;9(5):803-6. doi: 10.4184/asj.2015.9.5.803. Epub 2015 Sep 22.
Vertebral fractures occur with only slight trauma in patients with diffuse idiopathic skeletal hyperostosis (DISH). However, a lumbar vertebra fracture, due to an intraoperative body position has not been previously reported. An 87-year-old woman with kyphosis sustained a left trochanteric fracture of her femur. The patient was placed in a supine position during the operation. Postoperatively, the patient experienced severe right thigh pain. Magnetic resonance imaging revealed an L4 vertebral fracture. Computed tomography revealed ankylosis from the upper thoracic spine to the sacrum. While in a supine position under general anesthesia, the contact of the patient's lower back with operating table likely created a fulcrum at her lumbosacral spine acting as a long lever arm, bearing the mass of her upper body. We performed L1-S2 posterior stabilization. DISH patients with kyphosis placed in a supine position have an increased risk for lumbar vertebral fracture.
在弥漫性特发性骨肥厚（DISH）患者中，仅轻微外伤即可导致椎体骨折。然而，因术中体位导致腰椎骨折的情况此前尚未见报道。一名87岁患有脊柱后凸的女性发生了左侧股骨转子间骨折。手术期间患者处于仰卧位。术后，患者出现严重的右大腿疼痛。磁共振成像显示L4椎体骨折。计算机断层扫描显示从胸椎上段至骶骨存在融合。在全身麻醉下处于仰卧位时，患者下背部与手术台的接触可能在其腰骶椎形成一个支点，起到长杠杆臂的作用，承受上半身的重量。我们进行了L1 - S2后路稳定手术。患有脊柱后凸的DISH患者处于仰卧位时发生腰椎骨折的风险增加。
