Miyamoto Kazuyuki, Sakakibara Mako, Yamaga Hiroki, Maeda Atsuo, Yagi Masaharu, Dohi Kenji
Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.
Department of Emergency Medicine, Showa University Northern Yokohama Hospital, 35-1 Chigasaki Chuo Tsuzuki-ku, Yokohama City, 224-8503, Japan.
Heliyon. 2024 Aug 8;10(16):e35994. doi: 10.1016/j.heliyon.2024.e35994. eCollection 2024 Aug 30.
Osteophytes grow on vertebral bodies and sometimes form a sharp edge, which can induce traumatic abdominal aortic injury (TAAI). However, these cases are extremely rare, although osteophytes grow in almost everyone with age. Herein, we report a rare case of TAAI due to a sharp osteophyte dislocation following a compression fracture, with a literature review. An 83-year-old man presented with back pain after a fall and subsequently developed shock. His lactate level was elevated on arrival, although we could not identify the cause of the shock. Enhanced computed tomography (CT) revealed a compression fracture of the lumbar spine, a sharp osteophyte penetrating the abdominal aorta, and contrast media spurting to the retroperitoneum. We immediately transfused, administered continuous noradrenaline to maintain his vital signs, and consulted a vascular surgeon and radiologist to arrange for an emergency operation. However, the operating room was not immediately available. We tried to evacuate a trauma center, which took time due to the COVID-19 outbreak. Thereafter, the patient's condition deteriorated, resulting in a pulseless electrical activity, and he passed away 3 h after arrival. Afterward, the previous CT image and a sharp osteophyte were observed in the lumbar vertebrae in contact with the abdominal aorta. There were only eight reports where the aorta was injured by osteophytes. From our review, unlike the proportion of common TAAI, injuries due to strong external forces were relatively small. There was no specific symptom, and the vertebral levels of osteophytes were concentrated in Th12-L3. The most common morphology of aorta injuries is pseudoaneurysm formation. Moreover, five of the patients developed hemorrhage. Considering these previous reports, we should pay attention to the aorta in front of the vertebral bodies regardless of the mechanism of injury when a CT image of patients shows osteophytes.
骨赘生长在椎体上，有时会形成尖锐边缘，可导致创伤性腹主动脉损伤（TAAI）。然而，尽管随着年龄增长几乎每个人都会出现骨赘，但这些病例极为罕见。在此，我们报告一例因压缩性骨折后尖锐骨赘脱位导致的TAAI罕见病例，并进行文献复习。一名83岁男性在跌倒后出现背痛，随后发展为休克。入院时其乳酸水平升高，尽管我们无法确定休克原因。增强计算机断层扫描（CT）显示腰椎压缩性骨折、尖锐骨赘穿透腹主动脉以及造影剂喷入腹膜后。我们立即进行输血，持续给予去甲肾上腺素以维持其生命体征，并咨询血管外科医生和放射科医生安排急诊手术。然而，手术室未能立即准备好。我们试图将患者转运至创伤中心，但由于新冠疫情爆发，这花费了一些时间。此后，患者病情恶化，出现无脉电活动，入院3小时后死亡。之后，在与腹主动脉接触的腰椎中观察到先前的CT图像和尖锐骨赘。仅有八篇关于骨赘损伤主动脉的报告。根据我们的综述，与常见TAAI的比例不同，因强大外力导致的损伤相对较少。没有特定症状，骨赘的椎体水平集中在胸12至腰3。主动脉损伤最常见的形态是假性动脉瘤形成。此外，五名患者出现了出血。考虑到这些先前的报告，当患者的CT图像显示有骨赘时，无论损伤机制如何，我们都应关注椎体前方主动脉的情况。
