延遲性假動脈瘤肇因於轉子間骨折──病例報告

Delayed Pseudoaneurysm as A Complication Following Intertrochanteric Fracture–A Case Report

在現今的高齡社會，髖部損傷的發生率亦逐年增加，但在治療這些疾病時總是會有未能滿足的期望。隨著骨質疏鬆症治療和骨折手術植入物的進步及改善，我們需要更加警惕一些罕見的併發症，以提高病人的照護品質。對於股動脈的血管損傷，例如其股骨深動脈分支，雖然不常見，但有若干病例在涉及股骨近端的骨折和其他髖部骨科手術後的中發生。在此，我們報告了一例延遲性偽動脈瘤，該病例發生在動態髖部螺釘系統固定手術後6個月。在這個病人身上，我們發現因為小轉子碎片向上位移後引起的血腫，我們在第二次手術中，同時修復了血管滲漏並重新固定了骨折碎片。透過PubMed和其他搜索引擎，我們檢索了從1978年到2015年的病例報告。這些案例大多數是在手術後的第1到30天內發現。其中血管損傷的發生可能是由於小轉子碎片、血管距離和選擇的植入物所致。然而過度位移的游離的小轉子碎片仍然是最主要原因。我們也歸納出其他風險因素，如使用動態髖螺釘（DHS）。據我們所知，近期報告中，血管損傷可以通過開放性修復方法或栓塞治療進行治療。如果小碎片位移超過2厘米，建議進行固定。
透過我們的病例報告，我們認為在轉子間骨折的病人群，仍需注意相關血管損傷的可能性。

With increasing hip injury incidence in the aged society, there are always unmet expectations. Despite improvement of osteoporosis treatment and fixation implants, we still need to be more aware of rare complications in order to improved care quality. Injuries to the femoral vessels such as profunda femoris artery are uncommon, but have already been described in cases following fractures and other orthopedic procedures involving the proximal femur. We reported a delayed pseudoaneurysm of the profunda femoris artery that presented 6 months after dynamic hip screw fixation. For the hematoma caused by migrated lesser trochanter fragments, we repaired the vessel leakage and resecured the fracture fragment. Previous case reports from 1978 to 2015 were collected via Pubmed and other search engines. Most of those cases was found since the first day to 30 days post-operation. The incidence of vascular injury may result from lesser trochanteric fragments, vessel distance and implants of choice. Free lesser trochanteric fragments after mobilization are still the number-one cause. Other risk factors such as use of dynamic hip screws (DHS) have also been important. To our knowledge, vessel injuries can treated with open repair methods or embolization, as suggested by more recent report. Lesser fragments are suggested to be fixed if displaced over 2cm.
Our case suggests that it is necessary to keep in mind the possibility of delayed pseudoaneurysm of the profunda femoris artery in intertrochanteric fractures.