髂腰肌血肿压迫腰丛神经11例临床分析  

Clinical analysis of 11 cases of iliopsoas muscle hematoma compressing lumbar plexus nerve

作　　者：李富波 龚格格 Li Fubo;Gong Gege(Department of Pain,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China;Department of Physical Diagnosis,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China)

机构地区：[1]西南医科大学附属医院疼痛科,泸州646000 [2]西南医科大学附属医院物理诊断科,泸州646000

出　　处：《中国基层医药》2023年第3期331-335,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨髂腰肌血肿压迫腰丛神经患者的发病原因、临床表现、治疗方法及预后。方法对西南医科大学附属医院2014年3月至2018年5月诊治的髂腰肌血肿压迫腰丛神经患者11例的临床资料进行分析。结果11例患者中,男10例、女1例,年龄(36.36±6.74)岁。凝血功能异常引起的8例,外伤导致的3例;髂腰肌血肿发生于左侧7例、右侧4例,其中中区出血11例,下区8例,上区2例。腰丛神经受累分布:股神经11例、股外侧皮神经6例、闭孔神经2例。11例患者采用对因治疗,随访3个月后11例患者血肿完全吸收,骨关节活动均正常,10例感觉和运动功能恢复,1例感觉功能恢复,运动功能恢复欠佳;随访1年后11例全部恢复正常。结论引起髂腰肌血肿的主要原因为凝血功能障碍、外伤,腰丛神经中的股神经和股外侧皮神经易受累,可引起下肢感觉运动障碍。凝血功能障碍引起的应补充凝血因子,纠正凝血功能;外伤引起的应早期行手术治疗,解除神经压迫;及时治疗,预后一般较好。Objective To investigate the etiology,clinical manifestations,treatment methods,and prognosis of patients with iliopsoas muscle hematoma compressing the lumbar plexus.Methods The clinical data of 11 cases of iliopsoas muscle hematoma oppressing the lumbar plexus nerve admitted to The Affiliated Hospital of Southwest Medical University between March 2014 and May 2018 were analyzed.Results Eleven patients,consisting of 10 men and 1 woman,aged(36.36±6.74)years were analyzed.Causes of iliopsoas muscle hematoma oppressing the lumbar plexus nerve included coagulation abnormality(n=8)and trauma(n=3).Iliopsoas muscle hematoma occurred on the left side in 7 cases and on the right side in 4 cases.Among them,11 cases had bleeding in the middle area,8 cases in the lower area,and 2 cases in the upper area.The involved lumbar plexus nerve included the femoral nerve(n=11),lateral femoral cutaneous nerve(n=6),and obturator nerve(n=2).Eleven cases underwent causative treatment(n=11).Three-month follow-up results showed that the hematomas were completely absorbed in 11 cases,and the bone and joint activities were normal.The sensory and motor functions were restored in 10 cases.The sensory function was restored,but the recovery of motor function was poor in 1 patient.All 11 cases returned to normal after 1 year.Conclusion The main causes of iliopsoas muscle hematoma are coagulation dysfunction and trauma.The femoral nerve and lateral femoral cutaneous nerve in the lumbar plexus are easily affected,which can cause lower limb sensory and motor disorders.As for iliopsoas muscle hematoma caused by coagulation abnormality,coagulation factors should be supplemented to correct coagulation function.As for iliopsoas muscle hematoma caused by trauma,early surgical treatment should be performed to relieve nerve compression.Timely treatment of iliopsoas muscle hematoma can generally acquire a good prognosis.

关 键 词：血肿 解剖学 局部 髂腰肌 压迫 腰骶丛 诊断 外科手术 治疗结果 回顾性研究 

分 类 号：R687[医药卫生—骨科学]