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Коллеги,Шуруп в аорте? Как снимать конструкцию? Нужен ли контроль аорты? Читайте ниже.С уважением, д-р Архипов dear all (George?) Got a note this morning requesting an opinion about a patient 25 yrs froma remote area of the country who received this "excellent" stabilization of a fracturedthoracic spine over a year ago.The original neurosurgeon liberated the patient for fullactivities and rehab etc.The rehab doc wants to know what to do. Looks to me like the patientwas screwed pretty good! any offers? Tom From: David Dent Tom, Harrington rods from a medical museum, with industrial strength screws from a boatbuilder. What are the current symptoms? David From: Mark Pleatman Interesting case. Findings on CT: all four pedicle screws have been placed improperly inthat they miss the vertebral bodies. In addition, the screws on the left side are impingingon the decending thoracic aorta. What I do NOT know is the nature of the original injury, orwhether or not that injury has resolved. I would recommend removal of the hardware. I don'tthink it's a good idea to leave those screws where they are. If the original fracture ishealed, nothing else needs to be done. Mark Pleatman From: Thomas Anthony Horan dear Mark, all the details are not yet available but the patient is coming to see us foradvice. We probably will see him in the early new year. i thought that the 4th picture showedthe screw to enter the aorta? He is a victim of a motor vehicle crash and thoracic vertebralfracture which appears healed. He was posteriorly decompressed and this device inserted. asyou say there isno evidenece that any of the fixation enters the bodies via the pediclesistead they have passed thru and their end are no where near where they ought to be. If I amcorrect (I would prefer not to be) the aortic intima has been breached by the screw. When thetime comes to take the screw out I thought we should have control of the aorta.What do you think? Tom From: Mark Pleatman Tom: I strongly doubt that the aorta is involved. When these screws are put in, they firstput in a probe, then a tap, then the screw. If the aorta was punctured, they would have knownat the time. You might call the original surgeon (if in fact he is a real doctor) and get hisfeedback. The additional morbidity of a prophylactic thoracotomy would be a higher pricethan I would be willing to subject my patient to. Besides, it would be exceptionallydifficult to control the aorta at this point, especially if you tried to specifically getenough control to be able to put sutures in the back wall. Of course, difficulty of doingsomething isn't necessary a reason not to do it if you think it is necessary. I just think itis highly unlikely that the aorta is injured. I showed the case to both a thoracic surgeon anda neurosurgeon. The thoracic surgeon suggested getting an arteriogram to see if the aorta isinvolved. The neurosurgeon agreed that the hardware should be removed. Mark From: Thomas Anthony Horan Mark Thank you. He is scheduled for a angio prior to transfer here. I keep going back to lookat that fourth image and although it is tough to believe the wall of the aorta seems toencompass the distal 1/2 of the screw. I have come to anticipate mal postion of screws thathave been inserted in hospitals that perhaps may not have the highest quality of equipment,including the human and radiological components. That having been said this case seems tosurpass the usual... one screw out of place or screwed into a disc etc. BTW I am notsuggesting that the screw was placed directly into the aorta but that moviment, pulse actionetc may have caused it to transgress the normal anatomical bounds without evident hemorrhage. Tom From: Mark Pleatman Tom: I think it's easy to be misled by CT scans. I'd bet a bottle of good Scotch whiskeythat the aorta is uninjured. Mark From: Thomas Anthony Horan Mark, would you accept a good bottle of cachaзa if I am wrong? Tom From: Mark Pleatman Tom:I had to look it up to make sure you weren't offering something like fermented sheep's blood.You've got a deal. Mark From: Paul Zaveruha But he can truly say the screw placement has a lifetime gurantee... < | >
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