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胫骨骨不连手术后腓动脉假性动脉瘤:一例报告并文献复习

Peroneal Artery Pseudoaneurysm after Surgery for Non-union of Tibia: A Case Report with Review of Literature.

作者信息

Upadhyaya Gaurav Kumar, Singh Pulkesh, Rawat Sanjay Singh, Srivastava Niraj Kumar, Dwivedi Abhishek

机构信息

Department of Cardiothoracic and Vascular Surgery, AIIMS, Raebareli, Uttar Pradesh, India.

Department of Orthopaedics, AIIMS, Raebareli, Uttar Pradesh, India.

出版信息

J Orthop Case Rep. 2023 Nov;13(11):83-88. doi: 10.13107/jocr.2023.v13.i11.4016.

Abstract

INTRODUCTION

Arterial pseudoaneurysm is a hematoma that is formed after damage to the arterial wall. We report a rare case of peroneal artery pseudoaneurysm after open reduction and internal fixation with interlocking nailing and partial fibulectomy for non-union for the right tibia in a 31-year-old male. The patient presented with a bleeding sinus over the leg swelling, and it was managed with an exploration of the pseudoaneurysm and ligation of the peroneal artery.

CASE REPORT

A 30-year-old male patient presented with a non-union tibia on the right side and had undergone plating of the tibia at another institute for a fracture of both bone legs approximately 18 months ago. The revision surgery was performed in which a previously inserted implant was removed and an interlocking nail was inserted, along with a partial fibulectomy. The post-operative period was uneventful. At 8 weeks after the second surgery, the patient came with a complaint of swelling at the outer aspect of the right leg. Computed tomography and angiography confirmed a peroneal artery pseudoaneurysm of 3.2 × 2.8 × 3.8 cm. Pseudoaneurysm was explored, and the artery was overrun with a Figure-8 stitches using a monofilamentous, and non-absorbable suture.

CONCLUSION

This case report highlights the occurrence of pseudoaneurysm after an orthoapedic procedure such as a partial fibulectomy. A high level of clinical suspicion, proper imaging, and early endovascular or surgical intervention is recommended to prevent complications.

摘要

引言

动脉假性动脉瘤是动脉壁受损后形成的血肿。我们报告一例罕见病例,一名31岁男性因右胫骨骨不连行切开复位交锁髓内钉内固定及部分腓骨切除术,术后出现腓动脉假性动脉瘤。患者腿部肿胀处有出血性窦道,通过探查假性动脉瘤并结扎腓动脉进行治疗。

病例报告

一名30岁男性患者右侧胫骨骨不连,约18个月前在另一家机构因双下肢骨折接受了胫骨钢板固定术。此次进行翻修手术,取出先前植入的内植物并插入交锁髓内钉,同时进行部分腓骨切除术。术后恢复顺利。第二次手术后8周,患者因右小腿外侧肿胀前来就诊。计算机断层扫描和血管造影证实存在一个大小为3.2×2.8×3.8厘米的腓动脉假性动脉瘤。对假性动脉瘤进行了探查,使用单丝不可吸收缝线以8字缝合法环绕动脉。

结论

本病例报告强调了诸如部分腓骨切除术等骨科手术后假性动脉瘤的发生情况。建议保持高度临床怀疑、进行适当影像学检查以及早期进行血管内或手术干预以预防并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a6d7/10664240/d18ac9924fcd/JOCR-13-83-g001.jpg

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