要旨電撃型脂肪塞栓症候群（電撃型FES）は外傷後短時間で発症し，致死的転帰をたどり生命予後も不良と報告されているがまとまった報告はない。神経学的後遺症を残した電撃型FESの1例を生命予後・神経学的予後を調査した文献レビューとともに報告する。症例は18歳の男性。交通事故により受傷し，救出後に当院救急搬送となった。来院時ショックはなく，意識レベルはGCS E3V4M6で軽度の不穏を認めた。顔面挫滅創を認めたがCTで頭蓋内損傷はなく，右肘開放性脱臼骨折および右大腿骨骨幹部骨折を認めた。受傷後8時間で骨折に対する緊急手術を行った。術中より血圧低下あり，術後に低酸素状態・意識レベル不良であり，再挿管・人工呼吸器管理となった。直後に行ったCTで肺野のすりガラス影の出現と脳浮腫を認め，翌日には点状出血の出現を認めたため電撃型FESの診断となった。集学的治療を行ったが，けいれんの出現があり，受傷後22日に撮像した頭部MRIでは多発性の陳旧性脳梗塞像を認めた。受傷後35日の転院時E3VTM3と意思疎通は困難であった。受傷後1年の時点で追視は可能だが意思疎通困難で，随意的な四肢運動は不可能である。文献レビューでは電撃型FESは日本語文献26例，英語文献14例の症例報告があり，死亡率は43～50%で，神経学的後遺症発生率は43～56%であった。

Sternovertebral fractures, which are simultaneous fractures of the spine and sternum, usually result to body trunk instability. This study aimed at investigating the characteristics, treatment strategies, and outcomes of sternovertebral fractures. Methods: We included 27 cases of sternovertebral fractures diagnosed between 2008 and 2020. The variables investigated were the fracture sites, treatment methods, type of bone union, and complaints. Results: Sternal fractures concerned the sternal body (22 cases), manubrium (3 cases), and both segments (2 cases). Nine patients had displaced sternal fractures. The spine fractures involved the cervical (2 cases), thoracic (17 cases), and lumbar (4 cases) segments, and there were four cases of multiple-level spine fractures. Types I, II, and III column injuries (Denis classification) were identified in 4, 13, and 10 cases, respectively. Complications included multiple rib fractures [12 cases (44%)], hemopneumothorax [7 cases (26%)], and lung contusion [6 cases (22%)]. There were no cases of cardiac or aortic injuries. The sternal fractures were treated conservatively in almost all the cases [26/27 cases (96%)]. Spinal fractures were treated surgically in 17 cases (63%). A satisfactory bone union was obtained in all the cases of sternal and spinal fractures, and complaints were noted in 2/27 (7%) sternal fractures and 14/27 (52%) spinal fractures. Conclusion:The most frequent clinical form of sternovertebral fractures was combined sternal body/thoracic spine fracture. In sternovertebral fractures, sternal fractures are mostly treated by conservative means.

We present a case of a morbidly obese 44–year–old woman with a short neck who had nasal discharge 3 days prior to admission. She was diagnosed with acute respiratory distress syndrome due to coronavirus disease 2019 (COVID–19) using severe acute respiratory syndrome–coronavirus–2 polymerase chain reaction test and was admitted to our hospital the following day. Her respiratory condition gradually worsened. On day 9 of hospitalization, she was intubated and transferred to our department. On day 4 after admission to the intensive care unit (ICU), her P/F ratio was 82.6. Therefore, extracorporeal membrane oxygenation (ECMO) was warranted. Since she had a short neck, the cannula could not be inserted through the jugular vein. Therefore, veno–venous ECMO was initiated through the left and right femoral veins. On day 30, the patient was weaned off ECMO. On day 36, she was extubated, and on day 47, she was discharged from the ICU. Finally, on day 55, she was discharged from the hospital. In morbidly obese patients with short necks, VV–ECMO with bilateral femoral venipuncture may be a treatment option. Thus, it is important to understand its advantages and disadvantages to ensure proper management.