Fried Sarah, Lipphardt Matthew, Moore Drew D
Department of Orthopedic Surgery, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI 48309, USA.
Department of Orthopedic Surgery, William Beaumont University Hospital, 3535 W 13 Mile Rd Suite 744, Royal Oak, MI 48073, USA.
J Orthop Case Rep. 2023 Feb;13(2):43-47. doi: 10.13107/jocr.2023.v13.i02.3550.
Pseudoaneurysms are vascular lesions occurring after injury to a blood vessel wall. Peripheral artery pseudoaneurysms as a fracture complication are uncommon and typically appear immediately after trauma or surgery. We report a unique case of sciatic nerve palsy associated with external iliac artery pseudoaneurysm arising 20 years after pelvic trauma, presenting within the fracture site as an erosive bone lesion masquerading as a possible malignancy. To the best of our knowledge, no cases of delayed external iliac artery pseudoaneurysm involving sciatic pain have been reported.
We present a 78-year-old female who sustained an acetabular fracture with an uneventful recovery for 20 years. The patient presented post-injury with symptoms and physical examination findings consistent with sciatic nerve palsy. Computed tomography angiography and duplex imaging revealed a pseudoaneurysm of the external iliac artery. The patient was taken to the operating room for endovascular repair of the external iliac artery using a covered stent.
This case of sciatic nerve palsy is a unique contribution to the literature concerning the specific vascular injury observed and the delayed presentation of pseudoaneurysm causing sciatic nerve palsy. Orthopedic surgeons must consider a wide differential when confronted with suspicious pelvic masses. Failure to diagnose these as a vascular etiology could prove catastrophic should the surgeon attempt an open debridement or sampling.
假性动脉瘤是血管壁损伤后出现的血管病变。外周动脉假性动脉瘤作为骨折并发症并不常见，通常在创伤或手术后立即出现。我们报告了一例独特的病例，一名患者在骨盆创伤20年后出现与髂外动脉假性动脉瘤相关的坐骨神经麻痹，在骨折部位表现为侵蚀性骨病变，看似可能为恶性肿瘤。据我们所知，此前尚无关于延迟出现的累及坐骨神经疼痛的髂外动脉假性动脉瘤病例的报道。
我们介绍了一名78岁女性，她曾发生髋臼骨折，术后恢复顺利，20年无症状。该患者受伤后出现与坐骨神经麻痹相符的症状和体格检查结果。计算机断层扫描血管造影和双功成像显示髂外动脉假性动脉瘤。患者被送往手术室，使用覆膜支架对髂外动脉进行血管内修复。
该例坐骨神经麻痹病例为相关文献提供了独特内容，涉及所观察到的特定血管损伤以及导致坐骨神经麻痹的假性动脉瘤的延迟表现。骨科医生在面对可疑的盆腔肿块时必须考虑多种鉴别诊断。如果外科医生尝试进行开放性清创或取样，未能将这些肿块诊断为血管病因可能会带来灾难性后果。
