Okuda Akinori, Konishi Hironobu, Maegawa Naoki, Masuda Keisuke, Shigematsu Hideki, Kawamura Kenji, Fukushima Hidetada, Tanaka Yasuhito
Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijotyo, Kashihara City, 654-8522, Nara, Japan.
Department of Orthopedic Surgery, Nara Medical University, 840 Shijotyo, Kashihara City, 654-8522, Nara, Japan.
Trauma Case Rep. 2021 Apr 21;33:100487. doi: 10.1016/j.tcr.2021.100487. eCollection 2021 Jun.
Diffuse idiopathic skeletal hyperostosis is associated with hyperextension injury of the spine caused by a minor trauma and may often be diagnosed late, thus preventing effective treatment. To date, there have been no reported cases of segmental arterial injury associated with a hyperextension injury caused by a minor trauma in super-elderly patients with diffuse idiopathic skeletal hyperostosis. Herein, we present the findings and treatment provided for a 92-year-old woman with a right massive hemothorax and 12th thoracic vertebral fracture. The patient was diagnosed with diffuse idiopathic skeletal hyperostosis. Bleeding stopped naturally, and we successfully treated the patient using posterior fixation with percutaneous pedicle screws. At 6 months post-surgery, there was no complication, instrumentation failure, or correction loss, and she could walk independently using a cane. To our knowledge, this is the first report of intercostal artery rupture and massive hemothorax associated with diffuse idiopathic skeletal hyperostosis fracture caused by a minor trauma. It is notable that diffuse idiopathic skeletal hyperostosis following a minor trauma in such elderly patients may cause segmental arterial rupture associated with spinal burst fracture and hyperextension injury.
弥漫性特发性骨肥厚与轻微创伤导致的脊柱过伸损伤相关，且常常诊断较晚，从而无法进行有效治疗。迄今为止，在患有弥漫性特发性骨肥厚的超高龄患者中，尚无因轻微创伤导致的过伸损伤伴节段性动脉损伤的病例报道。在此，我们报告了一名92岁女性患者的病例，该患者出现右侧大量血胸及第12胸椎骨折。患者被诊断为弥漫性特发性骨肥厚。出血自行停止，我们通过经皮椎弓根螺钉后路固定成功治疗了该患者。术后6个月，未出现并发症、内固定失败或矫正丢失，她能够借助拐杖独立行走。据我们所知，这是首例因轻微创伤导致弥漫性特发性骨肥厚骨折伴肋间动脉破裂和大量血胸的报道。值得注意的是，此类老年患者轻微创伤后的弥漫性特发性骨肥厚可能导致与脊柱爆裂骨折和过伸损伤相关的节段性动脉破裂。
