Takami Masanari, Iwasaki Yasuhiro, Okada Motohiro, Nagata Keiji, Shibata Naoaki, Kato Seiya, Yamada Hiroshi
Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan.
Department of Emergency and Critical Care Medicine, Wakayama Rosai Hospital, Wakayama, Japan.
Spine Surg Relat Res. 2022 Apr 12;6(5):464-471. doi: 10.22603/ssrr.2022-0001. eCollection 2022 Sep 27.
Massive hemothorax due to thoracic vertebral fractures (MHTVF) is a potentially lethal condition; however, its epidemiological and clinical data have been rarely described. Thus, in this study, we aimed to evaluate the incidence, predictive factors, and clinical features of MHTVF.
This retrospective cohort study enrolled 202 consecutive patients (136 male and 66 female patients) with thoracic vertebral fractures treated at our institute between January 2009 and December 2019. Their mean age was 60.7 (range, 17-90) years. Unstable fractures accounted for 57.4% (n=116) of the total fractures. The patients were then divided into MHTVF and non-MHTVF groups. We assessed the following MHTVF-associated factors: sex, age, history of medical conditions, anticoagulation/antiplatelet drug use, injury severity score, anatomical distribution of levels of the vertebral fractures, fracture type, and presence or absence of diffuse idiopathic skeletal hyperostosis (DISH) fracture.
In total, eight patients (six men and two women) with a mean age of 68.9 years (range, 22-85 years) were determined to exhibit MHTVF. The incidence of MHTVF in patients with unstable thoracic spinal fractures was 6.9%, whereas none of those with stable spinal fractures exhibited MHTVF. Factors like type B (p=0.049) and DISH (p=0.017) fractures were noted to be significantly associated with the MHTVF. Three patients experienced shock upon arrival, whereas two exhibited delayed shock. Chest tube insertion and/or emergency thoracotomy was performed. The survival rate was 100.0%.
MHTVF is not rare. Because type B and DISH fractures are identified as predictive factors of MHTVF, it must be carefully treated to avoid preventable death even after hospitalization in patients with these thoracic fractures.
胸椎骨折所致大量血胸（MHTVF）是一种潜在的致命病症；然而，其流行病学和临床数据鲜有描述。因此，在本研究中，我们旨在评估MHTVF的发病率、预测因素及临床特征。
这项回顾性队列研究纳入了2009年1月至2019年12月期间在我院接受治疗的202例连续胸椎骨折患者（136例男性和66例女性患者）。他们的平均年龄为60.7岁（范围17 - 90岁）。不稳定骨折占总骨折数的57.4%（n = 116）。然后将患者分为MHTVF组和非MHTVF组。我们评估了以下与MHTVF相关的因素：性别、年龄、病史、抗凝/抗血小板药物使用情况、损伤严重程度评分、椎体骨折水平的解剖分布、骨折类型以及是否存在弥漫性特发性骨肥厚（DISH）骨折。
共有8例患者（6例男性和2例女性）被确定为患有MHTVF，平均年龄为68.9岁（范围22 - 85岁）。不稳定胸椎骨折患者中MHTVF的发病率为6.9%，而稳定脊柱骨折患者均未出现MHTVF。发现B型（p = 0.049）和DISH（p = 0.017）骨折等因素与MHTVF显著相关。3例患者入院时出现休克，2例出现延迟性休克。进行了胸腔闭式引流和/或急诊开胸手术。生存率为100.0%。
MHTVF并不罕见。由于B型和DISH骨折被确定为MHTVF的预测因素，因此即使对于这些胸椎骨折患者住院后，也必须谨慎治疗以避免可预防的死亡。
