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插管后孤立性环状软骨骨折

Isolated Cricoid Fracture After Intubation.

作者信息

Pereira Cláudia, Lopes Freitas Rafaela, Pereira Cristina, Oliveira Nuno, Carvalho Daniela

机构信息

Anesthesiology, Hospital Pedro Hispano, Matosinhos, PRT.

Internal Medicine, Hospital Pedro Hispano, Matosinhos, PRT.

出版信息

Cureus. 2024 Nov 30;16(11):e74811. doi: 10.7759/cureus.74811. eCollection 2024 Nov.

DOI:10.7759/cureus.74811
PMID:39737316
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11683662/
Abstract

Isolated cricoid fractures are exceedingly rare but can be life-threatening. Injuries caused by minor neck trauma related to external laryngeal manipulation or an inappropriate tube cuff size have been reported in the literature. Symptoms typically appear immediately after the traumatic episode. Voice changes, respiratory distress, or deglutition problems may be present, although some patients may initially be asymptomatic. Here, we report a case of a 28-year-old woman with a history of recurrent dysphonia and respiratory distress after an episode of voluntary drug intoxication requiring orotracheal intubation and mechanical ventilation. The initial diagnostic workup was apparently normal, but conservative treatment did not resolve the symptoms. The progressive stridor episodes ultimately led to the correct diagnosis of a posterior cricoid fracture and abscess. The airway was secure with a transient tracheostomy, and the fracture was managed conservatively with no sequelae. A high level of suspicion is essential for the timely identification of these injuries to minimize the associated morbimortality, particularly in situations without obvious neck trauma and insidious symptoms.

摘要

孤立性环状软骨骨折极为罕见,但可能危及生命。文献中曾报道过因外部喉部操作或气管插管套囊尺寸不当导致的轻微颈部创伤所引起的损伤。症状通常在创伤事件后立即出现。可能会出现声音改变、呼吸窘迫或吞咽问题,不过有些患者最初可能并无症状。在此,我们报告一例28岁女性病例,该患者在一次自愿药物中毒发作后出现反复发声困难和呼吸窘迫,此次发作需要进行口气管插管和机械通气。最初的诊断检查结果显然正常,但保守治疗未能缓解症状。进行性喘鸣发作最终导致正确诊断为环状软骨后部骨折并伴有脓肿。通过临时气管切开术确保了气道安全,骨折采用保守治疗,未留下后遗症。对于及时识别这些损伤以将相关的发病率和死亡率降至最低而言,高度怀疑至关重要,尤其是在没有明显颈部创伤和隐匿性症状的情况下。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2c6/11683662/d008d4cfa341/cureus-0016-00000074811-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2c6/11683662/e013b34a998b/cureus-0016-00000074811-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2c6/11683662/d008d4cfa341/cureus-0016-00000074811-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2c6/11683662/e013b34a998b/cureus-0016-00000074811-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e2c6/11683662/d008d4cfa341/cureus-0016-00000074811-i02.jpg

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本文引用的文献

1
Isolated Cricoid Fracture and Thyroid Hematoma in Blunt Injury of the Neck.颈部钝性损伤中的孤立性环状软骨骨折和甲状腺血肿。
Indian J Otolaryngol Head Neck Surg. 2022 Dec;74(Suppl 3):5028-5032. doi: 10.1007/s12070-021-02659-w. Epub 2021 May 27.
2
Isolated comminuted fracture of the cricoid cartilage and narrowing of the airway after a traumatic blunt injury of the neck: a case report.颈部钝性外伤后环状软骨孤立性粉碎性骨折及气道狭窄:一例报告
Int J Emerg Med. 2022 Oct 5;15(1):55. doi: 10.1186/s12245-022-00459-9.
3
Clinical, Radiologic, and Endolaryngeal Findings in Laryngeal Fractures: A 15-Year Case Series.
喉骨折的临床、放射学及喉内表现:一项15年的病例系列研究
OTO Open. 2022 Feb 25;6(1):2473974X221080164. doi: 10.1177/2473974X221080164. eCollection 2022 Jan-Mar.
4
A Novel Concept for Surgical Management of a Traumatic Comminuted Cricoid Fracture.一种用于外伤性粉碎性环状软骨骨折手术治疗的新方法。
Ear Nose Throat J. 2024 Feb;103(2):NP128-NP131. doi: 10.1177/01455613211040579. Epub 2021 Sep 1.
5
CT-based assessment of laryngeal fracture patterns and associated soft tissue abnormality.基于 CT 的喉骨折类型评估及其相关软组织异常。
Eur Radiol. 2021 Jul;31(7):5212-5221. doi: 10.1007/s00330-020-07548-4. Epub 2021 Jan 6.
6
Unique presentation of cricoid cartilage fracture causing intermittent dyspnea without preceding trauma.环状软骨骨折的独特表现导致间歇性呼吸困难,且无先前创伤史。
Nagoya J Med Sci. 2019 Nov;81(4):687-691. doi: 10.18999/nagjms.81.4.687.
7
Bone density status in a large population of patients with anorexia nervosa.大量神经性厌食症患者的骨密度状况。
Bone. 2020 Feb;131:115161. doi: 10.1016/j.bone.2019.115161. Epub 2019 Nov 23.
8
Laryngeal Fracture after Blunt Cervical Trauma in Motorcycle Accident and Its Management.摩托车事故中钝性颈部创伤后的喉骨折及其处理
Case Rep Otolaryngol. 2017;2017:9321975. doi: 10.1155/2017/9321975. Epub 2017 Feb 2.
9
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Laryngoscope. 2014 Nov;124(11):2583-5. doi: 10.1002/lary.24819. Epub 2014 Jul 10.
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Management of acute blunt and penetrating external laryngeal trauma.急性钝性和穿透性喉外伤的处理。
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