Ferrando Lacarte Ignacio, Clemente Sarasa Carolina, Domingo Sanchez María Dolores, Cánovas Pareja Carmen
Servicio de Geriatría, Hospital de Barbastro, Barbastro, Huesca, España.
Servicio de Medicina Interna, Hospital Obispo Polanco, Teruel, España.
Rev Esp Geriatr Gerontol. 2020 Mar-Apr;55(2):120-122. doi: 10.1016/j.regg.2019.06.003. Epub 2019 Jul 25.
75-year-old patient with a history of acenocumarol anticoagulated atrial fibrillation, which shows pain, functional impotence and right lower limb paresthesias after fall. Studies evidenc evertebral fracture L5 and haematoma on right iliac muscle, proceeding to surgical drainage, suspension of acenocumarol, and onset of apixaban. After treatment persisted femoral neuropathy, which not allowed complete functional recovery. DISCUSSION: Femoral neuropathy as possible cause of compressive hematoma over iliopsoas muscle or secundary to lumbar canal stenosis and contact with L4 root. In both of the misit posible to observe weakness of proximal lower limb musculature. Haematoma was suspected due to lower back pain, flank mass and hypovolemia. Handlingis based on the severity of the symptomatology, from conservative to surgical drainage to reduce sequelae and bleeding complications. Apixaban has shown a higher safety profile. Stabilization of lumbar fracture allowed partial functional recovery.
一名75岁有醋硝香豆素抗凝治疗房颤病史的患者，跌倒后出现疼痛、功能性阳痿及右下肢感觉异常。检查发现L5椎体骨折及右髂肌血肿，遂行手术引流，停用醋硝香豆素，并开始使用阿哌沙班。治疗后股神经病变持续存在，导致功能无法完全恢复。讨论：股神经病变可能是髂腰肌受压血肿的原因，或继发于腰椎管狭窄及与L4神经根接触。在这两种情况下，都可能观察到下肢近端肌肉组织无力。因下背痛、侧腹肿块及血容量不足怀疑有血肿。治疗根据症状的严重程度而定，从保守治疗到手术引流，以减少后遗症和出血并发症。阿哌沙班已显示出更高的安全性。腰椎骨折的稳定使功能部分恢复。
