Miyake Takahito, Okada Hideshi, Kanda Norihide, Mizuno Yosuke, Suzuki Kodai, Doi Tomoaki, Yoshida Takahiro, Yoshida Shozo, Ogura Shinji
Advanced Critical Care Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
Int J Emerg Med. 2023 Feb 16;16(1):7. doi: 10.1186/s12245-023-00488-y.
Spinal ankylosing disorders (SADs) refer to a group of conditions resulting in spontaneous or postsurgical ossification and fusion of the spinal segments. The spine becomes increasingly susceptible to injury over time such that even low-energy trauma can cause a spinal injury. We report two cases of SADs, associated with massive thoracic hemorrhage.
The first patient was an 85-year-old male, who suffered from a vehicular crash. He was diagnosed with a fracture of the first lumbar vertebra, accompanied by SADs. Intubation was required, and thoracic drainage tubes were inserted. The patient underwent a massive transfusion and thoracotomy with packing. Despite prompt treatment, the hemorrhage from the vertebral fracture was uncontrolled, and the patient died 180 min after the injury. The second case features an 88-year-old male who fell from a height. He was diagnosed with flail chest, hemothorax, pneumothorax, and a fracture of the eighth thoracic vertebra with SADs. After intubation, four thoracic drainage tubes were placed, and a massive transfusion was conducted. He died after 3 days due to hypoxemia secondary to persistent bleeding of the vertebral fracture for 24 h.
The patients died of persistent thoracic hemorrhage, and the sources of bleeding were the fracture site of the spine fractures. Controlling spinal hemorrhage is difficult due to the absence of a bleeding artery, which is managed via trans-arterial embolization. This report emphasized that fracture of SADs could be a fatal disease that requires prompt intervention.
脊柱强直性疾病（SADs）是指一组导致脊柱节段自发性或手术后骨化和融合的病症。随着时间的推移，脊柱越来越容易受伤，以至于即使是低能量创伤也可能导致脊柱损伤。我们报告两例与大量胸腔出血相关的SADs病例。
首例患者为一名85岁男性，遭遇车祸。他被诊断为第一腰椎骨折，并伴有SADs。需要进行插管，并插入胸腔引流管。患者接受了大量输血和开胸填塞术。尽管治疗及时，但椎体骨折出血无法控制，患者在受伤后180分钟死亡。第二例为一名88岁男性，从高处坠落。他被诊断为连枷胸、血胸、气胸以及第八胸椎骨折并伴有SADs。插管后，放置了四根胸腔引流管，并进行了大量输血。他在3天后因椎体骨折持续出血24小时继发低氧血症而死亡。
患者死于持续性胸腔出血，出血来源为脊柱骨折部位。由于没有出血动脉，控制脊柱出血很困难，可通过经动脉栓塞进行处理。本报告强调，SADs骨折可能是一种需要及时干预的致命疾病。
