Disruption of The Subclavian Artery Following Contralateral First Rib and Clavicle Fractires:Case Report

對側鎖骨與肋骨骨折引致鎖骨下動脈破裂：病例報告

郭華基(Va-Kei Kok) ； 許家祥(Victor Ka-Siong) ； 吳俊仁(Chen-JEn Wu)

《中華民國急救加護醫學會雜誌》 11卷1期 (2000/03) Pp. 26-32

https://doi.org/10.30018/JECCM.200003.0006

摘要

交通意外引致鎖骨下動脈受傷比較鮮見於文獻報告。我門經歷一例對側鎖骨與第一肋骨骨折，造成鎖骨下動脈破裂。患者是摩托車騎車，車禍送抵本院，據陳述意外發生過程，當機車傾倒往左側著地時，患者的頸部瞬間斜向右側，同時右胸部撞到機車右側把手，主拆胸部和頸部疼痛。遵照美國外科醫學會頒訂的高級外傷救命術指引進行急救，初期理學檢查僅發現右側第一肋骨骨折和懷疑右鎖骨無錯位線狀骨折，同時左側肺尖輕度血胸，生命徵象穩定，呼吸順暢；住院六小時後出現出血性休克和左側血胸擴大，雖經胸管引流和體液補充治療，繼續再予觀察治療二小時，臨床症狀仍持續發生出血性休克情形，遂安排開胸手術探查，發現左鎖骨下動脈近端破裂，經手術縫合，病患七天院。本例的受傷機轉，我們推論可能是左側頸肩部突然承受外力，頸部同時往受力點過度伸張和轉向。致使左側鎖骨下動脈轉折處的曲折率突然增大，造成血管壁斷裂。

關鍵字

非穿刺血管傷害 ； 鎖骨下動脈破裂

並列摘要

Motorcycle accidents are very common, but associated subclavian artery injury is rearely reported in the liter ature. We encountered one case where the left subclavian artery was disrupted following contralateral first rib and clavicle fractures. The patient, who wad admitted to our hospital after a motorcycle accident, complained of chest and neck pain. The treatment wad based on the guidelines of the american College of Surgeons’ ATLS manual. Serial chest films revealed hemothorax on the left side. The patient remained unstable eight hours after admission. The disruption of the subclavian attery, close to the proximal aortic arch , wad confirmed during thoractomy. The patient wad discharged 7 days after repair. The injury mechanism may be a shearing force produced by tilting of the neck , causing longitudinal tension on the subclavian artery.

並列關鍵字

non-penetrating vascular injury ； subclavian artery disruption