De la Corte-Rodriguez Hortensia, Rodriguez-Merchan E Carlos
aDepartment of Physical Medicine and Rehabilitation bDepartment of Orthopaedic Surgery. 'La Paz' University Hospital, Madrid, Spain.
Blood Coagul Fibrinolysis. 2014 Dec;25(8):787-94. doi: 10.1097/MBC.0000000000000159.
Between 10 and 23% of bleeding episodes in the musculoskeletal system of haemophilia patients occur in the muscles. Until now, the most widely accepted treatment for muscle haematomas in patients with haemophilia has been a combination of rehabilitation and intravenous infusion of replacement clotting factor, until the haematoma completely disappears. The only way to prevent muscle bleeds in haemophilia is primary haematological prophylaxis (from cradle to college). Home treatment is currently the standard of care for patients with severe haemophilia. When a muscle bleed is suspected, confirmation must be achieved by means of imaging tests (ultrasound, MRI, CT). Then, immediate (early) enhanced on-demand haematological treatment must be started until the full disappearance of the haematoma. If untreated, muscle bleeds can cause complications such as nerve injury, compartment syndrome, myositis ossificans, pseudotumour, and even infection (abscess). Currently, the literature for muscle hematomas in the nonhaemophiliac population suggests that ultrasound-guided percutaneous drainage, or surgical drainage performed as open surgery if percutaneous drainage fails, could be beneficial in terms of achieving better and faster symptom relief. Ultrasound-guided haematoma evacuation is a well tolerated procedure. However, the proportion of unsuccessful evacuations and hematoma recurrence is substantial (13%). Such a rate of unsuccessful evacuation is because of excessive density and/or viscosity of the content. Ideally, haematoma evacuation must be performed before 3-5 days since the beginning of the muscular bleed. Although we have not found publications about ultrasound-guided decompression of muscle haematomas in haemophilia, the current status of progress in both the haematological and ultrasound fields leads us to think that this technique should be increasingly considered for the treatment of haemophilia patients, especially in the case of large haematomas in the liquid phase.
血友病患者肌肉骨骼系统出血事件中有10%至23%发生在肌肉。到目前为止，血友病患者肌肉血肿最广泛接受的治疗方法是康复治疗与静脉输注替代凝血因子相结合，直到血肿完全消失。预防血友病患者肌肉出血的唯一方法是一级血液学预防（从摇篮到大学）。家庭治疗目前是重度血友病患者的标准治疗方式。当怀疑有肌肉出血时，必须通过影像学检查（超声、磁共振成像、计算机断层扫描）来确诊。然后，必须立即（早期）开始强化按需血液学治疗，直到血肿完全消失。如果不进行治疗，肌肉出血会导致神经损伤、骨筋膜室综合征、骨化性肌炎、假肿瘤等并发症，甚至感染（脓肿）。目前，关于非血友病患者肌肉血肿的文献表明，超声引导下经皮引流，或在经皮引流失败时进行开放手术的外科引流，在更好更快地缓解症状方面可能是有益的。超声引导下血肿清除术是一种耐受性良好的手术。然而，清除失败和血肿复发的比例相当高（13%）。这样的清除失败率是由于内容物密度过高和/或粘度太大。理想情况下，血肿清除必须在肌肉出血开始后的3至5天内进行。虽然我们尚未找到关于超声引导下血友病患者肌肉血肿减压的出版物，但血液学和超声领域的当前进展状况使我们认为，这种技术应越来越多地被考虑用于治疗血友病患者，尤其是在液相大血肿的情况下。
