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支架置入术有效治疗伴有右颈总动脉夹层和狭窄的创伤性穿透性颈部损伤:一例报告并文献复习

Traumatic Penetrating Neck Injury with Right Common Carotid Artery Dissection and Stenosis Effectively Managed with Stenting: A Case Report and Review of the Literature.

作者信息

Richard Seidu A, Zhang Chang Wei, Wu Cong, Ting Wang, Xiaodong Xie

机构信息

Department of Neurosurgery, West China Hospital, Sichuan University, 37 Guo Xue Xiang Road, Chengdu, Sichuan 610041, China.

Department of Surgery, Volta Regional Hospital, P.O. Box MA-374, Ho, Ghana.

出版信息

Case Rep Vasc Med. 2018 Jun 10;2018:4602743. doi: 10.1155/2018/4602743. eCollection 2018.

Abstract

INTRODUCTION

Penetrating neck injuries (PNI) are common and associated with arterial and other neuronal injuries. Although many authors have written on penetrating and blunt carotid artery injuries as a result of PNI or traumatic neck injuries, no one has reported a case or case series on PNI that resulted in blunt carotid dissection and stenosis.

CASE PRESENTATION

We present a case of 40-year-old building and construction male worker who slipped and fell on an iron rod that resulted in penetrating wound on the right side of the anterior neck a week prior to presenting at our facility. He pulled out the iron rod immediately. Computer tomography angiography (CTA) done revealed C2-C4 transverse process fractures on the right side and a fracture at the right lamina of C3 and right common carotid artery dissection with stenosis. He was successfully treated with stenting via endovascular approach.

CONCLUSIONS

We adopt the view that patient should never pull out objects that result in PNI because of complex neurovascular architecture of the neck. The mortality rate of our patient will have doubled if the iron rode penetrated the common carotid artery. The gold standard treatment option for carotid artery dissection and stenosis is endovascular approaches.

摘要

引言

颈部穿透伤(PNI)很常见,且与动脉及其他神经损伤相关。尽管许多作者撰写过关于因颈部穿透伤(PNI)或颈部创伤导致的穿透性和钝性颈动脉损伤的文章,但尚无一人报道过因颈部穿透伤导致钝性颈动脉夹层和狭窄的病例或病例系列。

病例报告

我们报告一例40岁的建筑工人,他在一周前滑倒在一根铁棍上,导致前颈部右侧出现穿透伤,随后前来我们的医疗机构就诊。他当即拔出了铁棍。计算机断层血管造影(CTA)检查显示右侧C2 - C4横突骨折、C3右侧椎板骨折以及右侧颈总动脉夹层伴狭窄。通过血管内介入方法进行支架置入,他得到了成功治疗。

结论

我们认为,由于颈部复杂的神经血管结构,患者绝不应该拔出导致颈部穿透伤的物体。如果铁棍穿透颈总动脉,我们这位患者的死亡率将会翻倍。治疗颈动脉夹层和狭窄的金标准治疗方案是血管内介入方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9adb/6015681/a044602e1d54/CRIVAM2018-4602743.001.jpg

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