Ailaney Nikhil, O'Connell Robert, Giambra Laura, Golladay Gregory
Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.
Department of Orthopaedic Surgery, VCU Health, Richmond, Virginia, USA.
BMJ Case Rep. 2019 Oct 23;12(10):e231490. doi: 10.1136/bcr-2019-231490.
A 79-year-old woman with a history of osteoporosis treated with alendronate presented to the orthopaedic clinic with persistent left hip pain. X-ray and bone scan revealed an atypical femoral fracture associated with bisphosphonate use. The fracture was repaired with antegrade femoral intramedullary fixation. Her postoperative course was complicated by acute blood loss anaemia requiring several packed red blood cell transfusions and progressive thigh ecchymosis. CT angiography demonstrated extravasation of contrast from the superior gluteal artery (SGA). Subsequent angiography revealed an SGA pseudoaneurysm above the intramedullary nail, which was coil embolised. Iatrogenic SGA injury secondary to femoral intramedullary fixation is a rare complication, with only one previous case reported in the literature. Therefore, successful identification of the injury required attention to patient reported symptoms, neurovascular examinations and laboratory values to determine the cause of the patient's postoperative anaemia. The patient made a full recovery and did not have any long-term adverse effects following the embolisation.
一名79岁有骨质疏松病史且接受阿仑膦酸盐治疗的女性因持续左髋部疼痛就诊于骨科门诊。X线和骨扫描显示与双膦酸盐使用相关的非典型股骨骨折。采用顺行股骨髓内固定修复骨折。她的术后病程因急性失血性贫血而复杂化，需要多次输注浓缩红细胞以及大腿瘀斑进行性加重。CT血管造影显示造影剂从臀上动脉（SGA）外渗。随后的血管造影显示在髓内钉上方有一个SGA假性动脉瘤，通过弹簧圈栓塞治疗。股骨髓内固定继发的医源性SGA损伤是一种罕见的并发症，文献中仅报道过1例。因此，成功识别该损伤需要关注患者报告的症状、神经血管检查和实验室值，以确定患者术后贫血的原因。患者完全康复，栓塞后未出现任何长期不良反应。
