41例血友病患者髂腰肌出血的临床特征及康复治疗  

Clinical characteristics and rehabilitation treatment of illiopsoas hemorrage in 41 patients with hemophilia

作　　者：陈丽霞 华宝来 刘颖 罗岚 张建平 张含英 赵永强 

机构地区：[1]中国医学科学院、北京协和医学院北京协和医院物理医学康复科,100730 [2]血液科

出　　处：《中华血液学杂志》2012年第5期406-408,共3页Chinese Journal of Hematology

基　　金：首都医学发展科研基金（2005-1024）

摘　　要：目的分析血友病患者髂腰肌出血的临床特征和康复治疗临床效果。方法对2006年1月-2010年12月收治的血友病髂腰肌出血患者的症状、体征、并发症及康复治疗进行回顾性分析。结果41例血友病髂腰肌出血患者均为男性，左侧髂腰肌出血20例、右侧18例，治疗期间先后双侧出血3例。中位年龄18（6-61）岁。初次髂腰肌出血中位年龄17（6-20）岁。34例（82．9％）患者合并股神经损伤，其中19例合并同侧膝关节出血。20例（48．8％）伴有股四头肌萎缩，2例有骨盆假性肿瘤形成，2例伴有永久性姿势异常。超声影像学表现主要为腰大肌区或腹股沟区低回声或低回声为主的混合回声区。34例患者在凝血因子替代保护治疗下完成8-12周康复治疗，其中33例患者血肿完全消失，患侧髋关节活动度恢复至出血前范围，合并股神经损伤的32例患者中27例（84．4％）股四头肌肌力恢复达到≥4级，20例（62．5％）患者遗留股神经分布区域感觉减低。结论本组血友病髂腰肌出血患者主要为青少年，股神经损伤和继发性膝关节出血的发生率较高，凝血因子保护下的康复治疗对于血肿的吸收及神经功能的恢复具有良好的疗效。Objective To analyze the clinical characteristics and effects of rehabilitation treatment on hemophiliacs with illiopsoas hemorrage. Methods The hemophilia patients with illiopsoas bleeding trea- ted in Peking Union Medical College Hospital between January 2006 to December 2010 were enrolled. The clinical characteristics including symptoms, signs, complications, and rehabilitation treatment were analyzed retrospectively. Results All of the forty-one hemophiliacs with illiopsoas bleeding were male, 20 cases wee the left bleeding, 18 the right, and 3 the bilateral. The median median age was 18 （6 -61 ） years old （y）. The median age of the illiopsoas bleeding for the first time was 17 （6 - 20 ） y. 34 patients accompanied with femoral nerve injury, 19 of them had secondary knee bleeding on the same side. 20 patrents had quadriceps atrophy. Pelvic pseudotumor developed in 2 patients and permanent abnormal posture in 2 patients. The main finding of the ultrasound image was low-echo mass in illiopsoas muscles or inguinal region. 34 patients re- ceived rehabilitation therapy for 8 - 12 weeks under the support of factor replacement, complete hematomas absorption in 33 of them, with hip range of motion recovering back to baseline. 27 of 32 （84.4%） cases with femoral nerve injury got quadriceps strength above 4/5 grade, 20 cases of femoral nerve injury （62.5%） still had numbness on front of their thigh after treatment. Conclusions In this cohort of illiopsoase bleeding, most of the patients are adolescent. High prevalence of the femoral nerve injury and the secondary knee bleed- ing are found. Rehabilitation treatment under the support of factor replacement is safe and effective on hemato- ma absorption and neurological function reeovery.

关 键 词：血友病 髂腰肌出血 临床特征 

分 类 号：R554.1[医药卫生—血液循环系统疾病]