Nakao Shota, Ishikawa Kazuo, Ono Hidefumi, Kusakabe Kenji, Fujimura Ichiro, Ueno Masato, Idoguchi Koji, Mizushima Yasuaki, Matsuoka Tetsuya
Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku-Ourai-Kita, Izumisano-shi, Osaka, 598-0048, Japan.
Emergency Department, Seikeikai Hospital, 1-1-1 Minami-Yasui-cho, Sakai-ku, Sakai-shi, Osaka, 590-0064, Japan.
Eur J Trauma Emerg Surg. 2019 Apr;45(2):353-363. doi: 10.1007/s00068-018-0907-x. Epub 2018 Jan 24.
Lumbar vertebral fracture (LVF) infrequently produces massive retroperitoneal hematoma (RPH). This study aimed to systematically review the clinical and radiographic characteristics of RPH resulting from LVF.
For 193 consecutive patients having LVF who underwent computed tomography (CT), demographic data, physiological conditions, and outcomes were reviewed from their medical records. Presence or absence of RPH, other bone fractures, or organ/vessel injury was evaluated in their CT images, and LVF or RPH, if present, was classified according to either the Orthopaedic Trauma Association classification or the concept of interfascial planes.
RPH resulting only or dominantly from LVF was found in 66 (34.2%) patients, whereas among the others, 64 (33.2%) had no RPH, 38 (19.7%) had RPH from other injuries, and 25 (13.0%) had RPH partly attributable to LVF. The 66 RPHs resulting only or dominantly from LVF were radiologically classified into mild subtype of minor median (n = 35), moderate subtype of lateral (n = 11), and severe subtypes of central pushing-up (n = 13) and combined (n = 7). Of the 20 patients with severe subtypes, 18 (90.0%) were in hemorrhagic shock on admission, and 6 (30.0%) were clinically diagnosed as dying due to uncontrollable RPH resulting from vertebral body fractures despite no anticoagulant medication.
LVF can directly produce massive RPH leading to hemorrhagic death. A major survey of such pathology should be conducted to establish appropriate diagnosis and treatment.
腰椎骨折（LVF）很少引起大量腹膜后血肿（RPH）。本研究旨在系统评价LVF所致RPH的临床和影像学特征。
对193例连续接受计算机断层扫描（CT）的LVF患者，从其病历中回顾人口统计学数据、生理状况和结局。在其CT图像中评估是否存在RPH、其他骨折或器官/血管损伤，对于存在的LVF或RPH，根据骨科创伤协会分类或筋膜间隙概念进行分类。
仅由LVF引起或主要由LVF引起的RPH在66例（34.2%）患者中发现，而在其他患者中，64例（33.2%）无RPH，38例（19.7%）因其他损伤导致RPH，25例（13.0%）RPH部分归因于LVF。仅由LVF引起或主要由LVF引起的66例RPH在影像学上分为轻微中位数的轻度亚型（n = 35）、外侧的中度亚型（n = 11）、中央上推的重度亚型（n = 13）和合并的重度亚型（n = 7）。在20例重度亚型患者中，18例（90.0%）入院时处于失血性休克，6例（30.0%）临床诊断为因椎体骨折导致无法控制的RPH而死亡，尽管未使用抗凝药物。
LVF可直接产生大量RPH导致出血性死亡。应进行此类病理的大规模调查以建立适当的诊断和治疗方法。
