足関節脱臼骨折手術中に肺塞栓症を発生するも救命しえた1例

Pulmonary Embolism Occurred in Ankle Surgery. Case Report

　44歳，男性．階段から転落して受傷し，左足関節脱臼骨折の診断で受傷後18日に観血的整復固定術を施行した．術中，タニケットを解除したところ解除2分後より最高血圧が50mmHgまで低下した．肺血栓塞栓症を疑い心肺蘇生を行い，ヘパリン5,000単位，TPA 520万単位を静注するなど，血栓溶解療法により救命し得た．現在，麻痺，脳高次機能障害を認めていない．足関節脱臼骨折の手術は肺血栓塞栓症予防ガイドラインによると中リスク群であるが，肥満，長期臥床などのリスクがある場合には下肢静脈エコーによる深部静脈血栓症の評価および，術前からの抗凝固療法や下肢静脈フィルターの設置等を検討する必要がある．

　Pulmonary embolism (PE) is a fatal complication in orthopaedic patients. There have been no reports on the incidence of PE during ankle operation. We report the case of 44-years-old man who sustained a left ankle fracture. 3 weeks following the initial injury, he was treated ORIF. In operation, when we released a thigh tourniquet, his blood pressure was suddenly down and his endtidal CO₂ was noted zero. He was immediately treated with tPA and heparin. He was presented to emargency room and angiographic study revealed PE in the bilateral pulmonary artery. Warfarin therapy was continued for six months, and approximately 1 year after operation, the ankle fracture had healed without complications.