Kovari Viktor Zsolt, Pecsi Ferenc, Cs Janvari Mate, Veres Robert
Hungarian Defense Forces Medical Centre, Department of Neurosurgery, Robert Karoly krt. 44, 1134 Budapest, Hungary.
Spinal Surgery and Scolisos Centre, Schön Klinik Neustadt, Am Kiebitzberg 10, 23730 Neustadt in Holstein, Germany.
Trauma Case Rep. 2017 Nov 6;12:48-53. doi: 10.1016/j.tcr.2017.10.019. eCollection 2017 Dec.
One blunt abdominal aortic disruption (BAAD) and one blunt thoracic aortic injury (BTAI) case are presented. Both aortic injuries were combined with spinal fractures. In the BAAD case the aortic pseudoaneurysm manifested just above the lumbar fracture while in the BTAI case the aortic injury appeared several vertebras below the thoracal fracture site, suggesting different mechanisms in the aortic wall damage. In both cases the aortic wall first was sealed, successfully, by endovascularly-placed stents, meaning the risks of open aortic reconstructive surgery could be avoided. The adjacent crucial vessel's preservation, despite the stent covering the left subclavian artery and the left common carotid artery in one of the cases was verified by post-operative computed tomography angiography (CTA) examination. In second stage those spinal fractures which were deemed unstable were stabilized by the fixateur interne (a transpedicular screw-rod system). With this treatment sequence we wanted to avoid the unnecessary risk of a possible rupture of the unsealed aortic wall during positioning for the spinal procedure and during the spinal surgery. Both patients recovered from their aortic and spinal injuries.
本文报告1例钝性腹主动脉破裂（BAAD）和1例钝性胸主动脉损伤（BTAI）病例。两例主动脉损伤均合并脊柱骨折。在BAAD病例中，主动脉假性动脉瘤出现在腰椎骨折上方，而在BTAI病例中，主动脉损伤出现在胸椎骨折部位下方几个椎体处，提示主动脉壁损伤机制不同。在两例病例中，主动脉壁首先通过血管内放置支架成功封闭，这意味着可以避免开放性主动脉重建手术的风险。尽管在其中1例病例中支架覆盖了左锁骨下动脉和左颈总动脉，但术后计算机断层扫描血管造影（CTA）检查证实相邻重要血管得以保留。在第二阶段，对于那些被认为不稳定的脊柱骨折，通过椎弓根螺钉系统进行内固定使其稳定。通过这种治疗顺序，我们希望避免在脊柱手术定位和手术过程中未封闭的主动脉壁可能破裂的不必要风险。两名患者均从主动脉和脊柱损伤中康复。
