骨赘在椎体上生长,有时形成锋利的边缘,可诱发创伤性腹主动脉损伤(TAAI)。然而,这些病例极为罕见,虽然骨赘在几乎每个人都随着年龄增长。在这里,我们报告了一例罕见的TAAI病例,原因是压缩性骨折后出现尖锐的骨赘脱位,与文献综述。一名83岁的男子在跌倒后出现背部疼痛,随后出现休克。他到达时乳酸水平升高,尽管我们无法确定休克的原因。增强计算机断层扫描(CT)显示腰椎压缩性骨折,穿透腹主动脉的尖锐骨赘,造影剂喷向腹膜后。我们立即输血,连续服用去甲肾上腺素来维持他的生命体征,并咨询了血管外科医生和放射科医生以安排紧急手术。然而,手术室没有立即可用。我们试图疏散创伤中心,由于COVID-19的爆发,这需要时间。此后,病人的病情恶化,导致无脉电活动,他在抵达后3小时去世。之后,在与腹主动脉接触的腰椎中观察到先前的CT图像和尖锐的骨赘。只有八份报告显示主动脉被骨赘损伤。从我们的审查来看,与普通TAAI的比例不同,由于强大的外力造成的伤害相对较小。没有具体症状,骨赘的椎体水平集中在Th12-L3。主动脉损伤最常见的形态是假性动脉瘤的形成。此外,其中五名患者出现出血。考虑到这些以前的报告,当患者的CT图像显示骨赘时,无论损伤机制如何,我们都应注意椎体前的主动脉。
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.