血友病髂腰肌血肿合并股神经损伤的临床特点与康复治疗效果

Clinical Characteristics and Physiotherapy for Hemophilia Patients with Femoral Nerve Injury due to Illiopsoas Hematoma

目的探讨血友病患者髂腰肌血肿合并股神经损伤的临床特点与康复治疗效果。方法收集北京协和医院2006年1月至2010年12月收治的34例血友病髂腰肌血肿合并股神经损伤患者的临床资料。患者的综合性康复治疗方案包括凝血因子替代治疗、关节保护与合理负重、本体感觉训练、神经营养药物治疗、神经肌肉电刺激、脉冲磁场和低强度激光。对患者的年龄特征、临床表现、并发症、超声影像、康复治疗效果进行回顾性分析。结果 34例血友病髂腰肌血肿合并股神经损伤患者均为男性,平均年龄为(17.6±3.3)岁。所有患者患侧髋关节伸展度降低,股四头肌肌力减低,股神经分布区浅感觉减低或消失;20例合并继发性膝关节出血,20例伴有股四头肌萎缩,1例有骨盆假性肿瘤形成;超声影像学主要表现为腰大肌区或腹股沟区低回声区。32例患者接受了凝血因子替代保护下综合性康复治疗并完成8～12周疗程,其中31例患者血肿完全消失,31例患侧髋关节活动度恢复至出血前范围,27例股四头肌肌力达到≥4级,12例股神经分布区域浅感觉功能恢复正常。结论本组血友病髂腰肌血肿合并股神经损伤的患者主要为青少年,具有较高的继发性膝关节出血的发生率。凝血因子替代下的综合性康复治疗对于血肿的吸收和神经功能的恢复具有良好疗效。

Objective To explore the clinical characteristics and physiotherapy for the Chinese hemo- philia patients with femoral nerve injury due to illiopsoas bleeding. Methods Thirty-four hemophilia patients with femoral nerve injury due to illiopsoas bleeding who had been treated in Peking Union Medical College Hospital between January 2006 and December 2010 were enrolled. The comprehensive treatment included factor replacement, joint protection and weight-bearing exercise, proprioception training, neurotrophic drugs, neuromuscular electronic stimulation, pulsed magnetic field, and low-intensity laser. The clinical characteris- tics including age distribution, clinical manifestations, complications, ultrasound image, and physiotherapy ef- ficacy were retrospectively analyzed. Results All the 34 patients were male and their mean age was （ 17.6 ± 3.3） years. All patients had loss of range of motion in the affected hip, decreased strength on quadriceps and deficiency of superficial sensory in front of thigh. Twenty patients had secondary knee bleeding. Twenty patients accompanied with quadriceps atrophy. Pseudotumor developed in one patient. The main findings of the ultra- sound image were low-echo mass in illiopsoas muscles or inguinal region. Thirty-two patients received 8- to 12- week comprehensive physiotherapy under the support of factor replacement. Thirty-one patients regained same range of motion of hip as baseline with hematoma disappeared completely, 27 patients got ≥4 grade of quadri- ceps force, and 12 patients obtained improved superficial sensory function of femoral nerve. Conclusions In this cohort of femoral nerve injury due to illiopsoas bleeding, most of the patients are adolescent. The high prev- alence of secondary knee bleeding is found. Comprehensive physiotherapy under the support of factor replace- ment is safe and effective for hematoma absorption and neurological function recovery.