Brandt S E, Zeegers W S, Ceelen T L
Department of Orthopaedic Surgery, University Hospital Leuven, Lubbeek, Belgium.
Eur Spine J. 1998;7(5):426-8. doi: 10.1007/s005860050102.
Fatal pulmonary fat embolism is a rare complication in elective orthopaedic surgery. It has been described previously as occuring during intramedullary manipulations and in trauma patients. We present the case of a 56-year-old slender housewife with severe radicular complaints because of lumbar spinal stenosis. She underwent a dorsal bilateral decompression of L4/L5 and L5/S1 in combination with an instrumented dorsolateral spinal fusion. Transpedicular fixation of L4/L5/S1 was accomplished by titanium Rodegerdts implants. Both iliac crests were used for harvesting autologous bone grafts. The intra-operative course was uneventful; however, 6 h after surgery, despite resuscitation, she expired. Autopsy revealed macroscopic gross fatty infiltration of lung parenchyma with oedema. We believe there is no relation between this complication and the transpedicular instrumentation. The position of the patient and the extent of the harvesting technique could be critical in preventing this serious complication.
致死性肺脂肪栓塞是择期骨科手术中一种罕见的并发症。此前曾有报道称其发生于髓内操作过程中以及创伤患者身上。我们报告一例56岁身材苗条的家庭主妇病例，她因腰椎管狭窄症出现严重的神经根症状。她接受了L4/L5和L5/S1节段的双侧后路减压术，并同时进行了器械辅助的后外侧脊柱融合术。L4/L5/S1节段的椎弓根固定采用钛制Rodegerdts植入物完成。双侧髂嵴均用于采集自体骨移植材料。手术过程顺利；然而，术后6小时，尽管进行了复苏，她仍死亡。尸检显示肺实质有肉眼可见的大量脂肪浸润并伴有水肿。我们认为这种并发症与椎弓根内固定器械无关。患者的体位和取材技术的范围可能是预防这种严重并发症的关键因素。
