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因放射性脊髓病所致完全性截瘫患者,其前下腰椎因神经源性异位骨化导致的髂总静脉血栓形成。

Deep vein thrombosis of the common iliac vein caused by neurogenic heterotopic ossification in the anterior lower lumbar spine of a patient with complete paraplegia due to radiation-induced myelopathy.

机构信息

Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul, Korea.

Department of Physical Medicine and Rehabilitation, Centre hospitalier de l'Université de Montréal, Montreal, Canada.

出版信息

J Spinal Cord Med. 2022 Mar;45(2):316-319. doi: 10.1080/10790268.2020.1807767. Epub 2020 Aug 18.

Abstract

: Deep vein thrombosis (DVT), a frequent complication of spinal cord injury, is occasionally caused by neurogenic heterotopic ossification (NHO). In most cases of NHO, the hip joint is affected. Herein, we present a case of paraplegia following radiation-induced myelopathy that presented with left leg swelling due to DVT in the common iliac vein (CIV) caused by venous compression by NHO on the anterior lower lumbar spine.: A 28-year-old man with complete paraplegia due to radiation-induced myelopathy presented with left lower extremity swelling 6 years after the onset of paraplegia. DVT in the left CIV was observed on computed tomography venography. The left CIV was significantly compressed between the NHO at the anterior longitudinal ligament of the lumbar spine and the right common iliac artery, suggestive of May-Thurner syndrome. Slightly distal to that compressed area, the left CIV was significantly compressed by the large NHO at the anterior longitudinal ligament of the lumbar spine.: We believe that such compression of the left CIV would have contributed to the development of DVT. This case shows that DVT might be caused by NHO at the anterior aspect of the lumbar vertebral body, and this may help clinicians identify the main cause of DVT in the leg.

摘要

深静脉血栓形成(DVT)是脊髓损伤的常见并发症,偶尔由神经源性异位骨化(NHO)引起。在大多数 NHO 病例中,髋关节受到影响。在此,我们报告一例因辐射诱导的脊髓病引起的截瘫,由于前腰椎下部 NHO 对静脉的压迫,导致 CIV 中的 DVT 引起左腿肿胀。

一名 28 岁男性因辐射诱导的脊髓病导致完全性截瘫,截瘫后 6 年出现左下肢肿胀。CT 静脉造影显示左髂总静脉 DVT。左髂总静脉在腰椎前纵韧带处的 NHO 和右侧髂总动脉之间受到明显压迫,提示 May-Thurner 综合征。在受压迫区域稍远端,左髂总静脉在腰椎前纵韧带处的大型 NHO 受到明显压迫。

我们认为,左髂总静脉的这种压迫可能促成了 DVT 的发生。该病例表明,DVT 可能由腰椎体前侧的 NHO 引起,这可能有助于临床医生确定腿部 DVT 的主要病因。

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本文引用的文献

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Ann Vasc Surg. 2013 Oct;27(7):984-95. doi: 10.1016/j.avsg.2013.05.001. Epub 2013 Jul 10.
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Mechanisms of thrombosis in spinal cord injury.脊髓损伤中的血栓形成机制。
Hematol Oncol Clin North Am. 2000 Apr;14(2):401-16. doi: 10.1016/s0889-8588(05)70141-6.

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