腰動脈損傷を伴った腰椎損傷の1例

Lumbar Spinal Injury Associated with a Lumbar Arterial Injury. Case Report

　症例は屋根から転落して受傷した67歳の女性で，初診時，vital signは安定していたが腰痛と右下腹部痛を認めた．腰椎単純X線像でL3椎体前方の骨折像と右腰筋陰影の膨隆を呈し，腹部造影CTでは血管外漏出像と血腫による後腹膜腔の腫大を示していた．徐々に血圧が低下したため，血管造影を行い右第4腰動脈の塞栓術を施行した．一時，血圧は安定したが，再出血のため死亡した．腰動脈損傷は腰椎脱臼骨折や多発性の横突起骨折に合併することが多いが，自験例のように軽微な腰椎損傷でも，止血困難な腰動脈損傷を呈することがあり注意を要する．

　We report the case of a 67-year-old woman who sustained a massive hemorrhage from a lumbar artery that was associated with a fracture of the lumbar spine.　The patient fell from a height of 2.7m and was sent to our emergency room.　Initial vital signs were stable.　A plain X-ray revealed a fracture of L3 without vertebral collapse, and asymmetrical enlargement of the right psoas muscle.　Enhanced abdominal computed tomography showed a hematoma in the right retroperitoneal space and arteriographic extravasation of the contrast medium.　Selective arteriography of the lumbar arteries confirmed an injury of the fourth lumbar artery and the extravasated contrast medium.　Transcatheter arterial embolization was temporarily successful, but the patient died of exsanguination within 14 hours after the injury, despite performing blood transfusions.