肩関節脱臼骨折に腋窩動脈損傷を合併し上肢麻痺を呈した1例

Paralysis Due to Axillary Artery Injury Associated with Fracture-Dislocation of the Shoulder. Case Report

　肩関節脱臼に腋窩動脈損傷を合併した稀な症例を経験したので報告する．症例は88歳の女性である．2006年11月に転倒し受傷した．左肩と左股関節の疼痛があり，翌日に当科を受診し，入院となった．左上腕骨近位端の4 part前方脱臼骨折と左大腿骨転子部骨折が認められた．入院後2日目に左手指の自動運動不能となり，皮膚蒼白，橈骨動脈の触知が不能となった．血管造影で腋窩動脈の閉塞が認められ，左腋窩―上腕動脈バイパス術を行った．血流再開時から橈骨動脈の拍動が触知され，術後10カ月経過した時点で循環障害は認められていない．

　Fractures of the proximal humerus with concomitant vascular injury are rare. We report a case in which injury of the axillary artery was associated with glenohumeral fracture-dislocation. The patient was an 88-year-old woman in whom radiographs showed a 4-part anterior fracture-dislocation of the left shoulder and trochanteric fracture of the left hip. Three days after the injury, her left arm was pale and cold below the shoulder. There was no pulse in the radial artery, and movement of the forearm and hand was impaired. Injury of the axillary artery was demonstrated by angiography. At surgery, the axillary artery was found to be occluded by a thrombus that had formed at the site of a complete circular intimal tear. The radial pulse returned after an axillary brachial artery bypass. At the 10-month follow-up examination there was no residual vascular deficit, but the neurological deficit persisted.