Chiara Osvaldo, Cimbanassi Stefania, Zoia Riccardo
Trauma Team Department DEA-EAS, Hospital Niguarda Ca'Granda, Milan, Italy.
Trauma Team Department DEA-EAS, Hospital Niguarda Ca'Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Eur J Trauma Emerg Surg. 2009 Jun;35(3):305-10. doi: 10.1007/s00068-008-8187-5. Epub 2008 Dec 19.
Transection of the thoracic aorta (TTA) remains a leading cause of death after blunt trauma. In this autopsy study, the natural history of this injury is reviewed.
All blunt trauma deaths that occurred in the Milano urban area over a period of one year were collected. Autopsies were available in all cases. Incidence, mechanisms, anatomical locations of TTA, deaths due to TTA or coexisting injuries, and times of death were reviewed. Cause of death was established. Death was attributed to TTA if its abbreviated injury score was six (hemorrhage not confined to the mediastinum).
199 cases of fatal blunt trauma were included, 72% of which were males; mean age 53 ± 21. A TTA was observed in 53 subjects (27%), with a significantly higher incidence between the ages of 45 and 64 years and after falls from height. The aorta was transected at the isthmus in 36% of cases. Victims with TTA had a higher pre-hospital mortality and more injuries to chest organs, the chest wall and pelvis. In victims with TTA, injury to the aorta was the cause of death in 58%. Only five patients with TTA survived more than 1 h, reaching the hospital alive; four of these died due to the rupture of a mediastinal hematoma during the first hours of in-hospital care.
This study demonstrates that TTA is a frequent cause of immediate deaths among blunt trauma victims. Patients with risk factors for TTA who reach the hospital alive need to be promptly investigated with a contrast CT scan. Evidence of mediastinal hematoma is suggestive for possible rapid evolution.
胸主动脉横断（TTA）仍是钝性创伤后死亡的主要原因。在这项尸检研究中，对该损伤的自然病程进行了回顾。
收集了米兰市区一年内发生的所有钝性创伤死亡病例。所有病例均进行了尸检。回顾了TTA的发病率、机制、解剖位置、因TTA或并存损伤导致的死亡情况以及死亡时间。确定了死因。如果其简略损伤评分为6分（出血不限于纵隔），则将死亡归因于TTA。
纳入199例致命钝性创伤病例，其中72%为男性；平均年龄53±21岁。53例（27%）观察到TTA，45至64岁之间以及从高处坠落之后的发病率显著更高。36%的病例中主动脉在峡部被横断。TTA受害者的院前死亡率更高，胸部器官、胸壁和骨盆的损伤更多。在TTA受害者中，主动脉损伤是58%的死亡原因。只有5例TTA患者存活超过1小时，活着到达医院；其中4例在住院治疗的最初几小时内因纵隔血肿破裂死亡。
本研究表明，TTA是钝性创伤受害者立即死亡的常见原因。活着到达医院的有TTA危险因素的患者需要立即进行增强CT扫描检查。纵隔血肿的证据提示可能会迅速进展。
