胸椎腰椎損傷の注意すべき合併損傷―伸展損傷は高リスク
はじめに：外傷に伴う胸椎腰椎損傷では伸展損傷は稀であり，多くは血管損傷を伴わないが，びまん性特発性骨増殖症（DISH）では伸展損傷からの血管・食道・尿管損傷といった重篤な合併症が報告されている．胸椎腰椎損傷に重篤な合併症を呈する骨折関連リスク因子について検討した．対象と方法：手術加療を行った176症例210椎のAO-A3，4，B，Cの胸椎腰椎損傷を対象とした．骨折脊椎周囲組織の脈管や臓器の損傷をsevere complicationと定義し，severe complicationを認めた群をS群，認めなかった群をN群として，2群比較を行った．結果：S群14例14椎，N群162例196椎で，分節...
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| Published in | Journal of Spine Research Vol. 13; no. 5; pp. 784 - 790 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脊椎脊髄病学会
20.05.2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1884-7137 2435-1563 |
| DOI | 10.34371/jspineres.2021-0070 |
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| Abstract | はじめに：外傷に伴う胸椎腰椎損傷では伸展損傷は稀であり，多くは血管損傷を伴わないが，びまん性特発性骨増殖症（DISH）では伸展損傷からの血管・食道・尿管損傷といった重篤な合併症が報告されている．胸椎腰椎損傷に重篤な合併症を呈する骨折関連リスク因子について検討した．対象と方法：手術加療を行った176症例210椎のAO-A3，4，B，Cの胸椎腰椎損傷を対象とした．骨折脊椎周囲組織の脈管や臓器の損傷をsevere complicationと定義し，severe complicationを認めた群をS群，認めなかった群をN群として，2群比較を行った．結果：S群14例14椎，N群162例196椎で，分節動脈損傷・胸管損傷・食道損傷・尿管損傷・横隔膜ヘルニア・大動脈プラークのshowering embolisationがsevere complicationであった．S群で有意に高齢，AO分類でBタイプが多く，伸展損傷，DISHが多かった．これらに対して多変量解析を行い，伸展損傷がsevere complicationのリスク因子であった．またS群で術後1ヶ月以内の死亡も有意に多かった．結語：胸椎腰椎損傷の伸展損傷はsevere complicationの合併リスクが高く注意を払うべきである． |
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| AbstractList | はじめに：外傷に伴う胸椎腰椎損傷では伸展損傷は稀であり，多くは血管損傷を伴わないが，びまん性特発性骨増殖症（DISH）では伸展損傷からの血管・食道・尿管損傷といった重篤な合併症が報告されている．胸椎腰椎損傷に重篤な合併症を呈する骨折関連リスク因子について検討した．対象と方法：手術加療を行った176症例210椎のAO-A3，4，B，Cの胸椎腰椎損傷を対象とした．骨折脊椎周囲組織の脈管や臓器の損傷をsevere complicationと定義し，severe complicationを認めた群をS群，認めなかった群をN群として，2群比較を行った．結果：S群14例14椎，N群162例196椎で，分節動脈損傷・胸管損傷・食道損傷・尿管損傷・横隔膜ヘルニア・大動脈プラークのshowering embolisationがsevere complicationであった．S群で有意に高齢，AO分類でBタイプが多く，伸展損傷，DISHが多かった．これらに対して多変量解析を行い，伸展損傷がsevere complicationのリスク因子であった．またS群で術後1ヶ月以内の死亡も有意に多かった．結語：胸椎腰椎損傷の伸展損傷はsevere complicationの合併リスクが高く注意を払うべきである． |
| Author | 中野, 健一 重松, 英樹 岡田, 博 福島, 英賢 田中, 康仁 小西, 浩允 前川, 尚宜 増田, 佳亮 奥田, 哲教 岩田, 栄一朗 川崎, 佐智子 |
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| References | 12) Okada E, Yoshii T, Yamada T, et al: Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis: A nationwide multi-institution survey. J Orthop Sci. 2019; 24: 601-606 5) Kagotani R, Yoshida M, Muraki S, et al: Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study. J Bone Miner Metab. 2015; 33: 221-229 6) Kim BS, Moon MS, Yoon MG, et al: Prevalence of diffuse idiopathic skeletal hyperostosis diagnosed by whole spine computed tomography: a preliminary study. Clin Orthop Surg. 2018; 10: 41-46 2) Burke DC: Hyperextension injuries of the spine. J Bone Joint Surg Br. 1971; 53: 3-12 3) Coimbra R, Yang J, Hoyt DB: Injuries of the abdominal aorta and inferior vena cava in association with thoracolumbar fractures: a lethal combination. J Trauma. 1996; 41: 533-535 9) Soundararajan DCR, Maheswaran A, Kumarasamy D, et al: Delayed presentation of urinoma mimicking spondylodiscitis secondary to ureteric injury following carrot stick fracture in ankylosing spondylitis. Eur Spine J. 2020; 29: 171-175 11) Morita S, Tsuji T, Fukushima T, et al: Arterial embolization of an extrapleural hematoma from a dislocated fracture of the lumbar spine: a case report. Scand J Trauma Resusc Emerg Med. 2009; 17: 27 1) Santoro G, Ramieri A, Chiarella V, et al: Thoraco-lumbar fractures with blunt traumatic aortic injury in adult patients: correlations and management. Eur Spine J. 2018; 27: 248-257 4) Inaba K, Kirkpatrick AW, Finkelstein J, et al: Blunt abdominal aortic trauma in association with thoracolumbar spine fractures. Injury. 2001; 32: 201-207 10) Okuda A, Konishi H, Maegawa N, et al: Intercostal artery rupture associated with thoracic spinal hyperextension injury caused by a minor trauma: A case report. Trauma Case Rep. 2021; 33: 100487 8) Kawasaki S, Shigematsu H, Matsumori H, et al: Ureteral injury as a possible complication of vertebral fracture in a patient with ankylosing spinal hyperostosis. J Orthop Sci. 2018; 23: 194-196 13) Okada E, Shimizu K, Kato M, et al: Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: Clinical characteristics by fracture level. J Orthop Sci. 2019; 24: 393-399 7) Groen FR, Delawi D, Kruyt MC, et al: Extension type fracture of the ankylotic thoracic spine with gross displacement causing esophageal rupture. Eur Spine J. 2016; 25: 183-187 |
| References_xml | – reference: 1) Santoro G, Ramieri A, Chiarella V, et al: Thoraco-lumbar fractures with blunt traumatic aortic injury in adult patients: correlations and management. Eur Spine J. 2018; 27: 248-257 – reference: 8) Kawasaki S, Shigematsu H, Matsumori H, et al: Ureteral injury as a possible complication of vertebral fracture in a patient with ankylosing spinal hyperostosis. J Orthop Sci. 2018; 23: 194-196 – reference: 6) Kim BS, Moon MS, Yoon MG, et al: Prevalence of diffuse idiopathic skeletal hyperostosis diagnosed by whole spine computed tomography: a preliminary study. Clin Orthop Surg. 2018; 10: 41-46 – reference: 7) Groen FR, Delawi D, Kruyt MC, et al: Extension type fracture of the ankylotic thoracic spine with gross displacement causing esophageal rupture. Eur Spine J. 2016; 25: 183-187 – reference: 2) Burke DC: Hyperextension injuries of the spine. J Bone Joint Surg Br. 1971; 53: 3-12 – reference: 4) Inaba K, Kirkpatrick AW, Finkelstein J, et al: Blunt abdominal aortic trauma in association with thoracolumbar spine fractures. Injury. 2001; 32: 201-207 – reference: 9) Soundararajan DCR, Maheswaran A, Kumarasamy D, et al: Delayed presentation of urinoma mimicking spondylodiscitis secondary to ureteric injury following carrot stick fracture in ankylosing spondylitis. Eur Spine J. 2020; 29: 171-175 – reference: 11) Morita S, Tsuji T, Fukushima T, et al: Arterial embolization of an extrapleural hematoma from a dislocated fracture of the lumbar spine: a case report. Scand J Trauma Resusc Emerg Med. 2009; 17: 27 – reference: 13) Okada E, Shimizu K, Kato M, et al: Spinal fractures in patients with diffuse idiopathic skeletal hyperostosis: Clinical characteristics by fracture level. J Orthop Sci. 2019; 24: 393-399 – reference: 5) Kagotani R, Yoshida M, Muraki S, et al: Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) of the whole spine and its association with lumbar spondylosis and knee osteoarthritis: the ROAD study. J Bone Miner Metab. 2015; 33: 221-229 – reference: 12) Okada E, Yoshii T, Yamada T, et al: Spinal fractures in patients with Diffuse idiopathic skeletal hyperostosis: A nationwide multi-institution survey. J Orthop Sci. 2019; 24: 601-606 – reference: 10) Okuda A, Konishi H, Maegawa N, et al: Intercostal artery rupture associated with thoracic spinal hyperextension injury caused by a minor trauma: A case report. Trauma Case Rep. 2021; 33: 100487 – reference: 3) Coimbra R, Yang J, Hoyt DB: Injuries of the abdominal aorta and inferior vena cava in association with thoracolumbar fractures: a lethal combination. J Trauma. 1996; 41: 533-535 |
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| Snippet | はじめに：外傷に伴う胸椎腰椎損傷では伸展損傷は稀であり，多くは血管損傷を伴わないが，びまん性特発性骨増殖症（DISH）では伸展損傷からの血管・食道・尿管損... |
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| Title | 胸椎腰椎損傷の注意すべき合併損傷―伸展損傷は高リスク |
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