大腿骨転子部骨折術後両下肢壊疽に陥った1例

Acute Arterial Occlusion after Open Reduction and Internal Fixation for Femoral Trochanteric Fracture. Case Report

　症例は83歳の女性で，大腿骨転子部骨折の術後から右下肢の麻痺，両下肢の冷感が出現した．MRアンギオグラフィで右は大腿動脈分岐部で，左は外腸骨動脈で閉塞していた．合併症に心房細動，心不全があり，骨折と手術侵襲による脱水，血液凝固能の亢進により，血栓・塞栓が生じたものと推定される．診断時には右下肢は麻痺しており血行再建の適応はなかった．筋腎代謝症候群は生じなかったが，右の股関節離断を行わざるを得なかった．大腿骨転子部骨折後における急性動脈閉塞症の発症はこれまで報告がなく，下肢の血行不良例に対しては術前評価を行い，術後血行動態の変化時には急性動脈閉塞症の合併も考慮に入れるべきと考えられた．

　Intramedullary nailing had been done to an eighty-nine-old female for her right intertrochanteric fracture.　Postoperatively her right lower extremity developed paralysis and her both legs appeared cold and pale.　On MRA her right femoral artery and left exrenal iliac artery had been occlusive.　This patient had atrial fibrillation and chronic heart failure preoperatively.　It presumed that thrombosis occurred for dehydration and accentuation of coagulation caused by stresses of the fracture and operative therapy.　The acute arterial occlusion had been supposed, but the right lower extremity from inguinal region and left foot became necrotic.　Disarticulation of right hip joint had done.　This acute arterial occlusion after intertrochanteric fractures has been not reported.　Attentions to circulations after the operation should be paid with consideration of this vascular disease.