Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, 317000, China.
BMC Surg. 2020 Nov 11;20(1):279. doi: 10.1186/s12893-020-00942-1.
Psoas hematoma rarely occurs in patients with spondylolisthesis who undergo posterior lumbar interbody fusion (PLIF) surgery.
Here we reported a case of a 57-year-old male patient diagnosed with spondylolisthesis who underwent PLIF at the local hospital. Seven days post-surgery, abdominal pain occurred, and the pain in the right lower limb gradually increased. The computerized tomography (CT) indicated a formation of hematoma around the psoas muscle. Digital-subtraction angiography (DSA) suggested a vascular injury, a rupture of the right segmental artery of the lumbar vertebral level 4. The patient then received DSA vascular embolization, after which the lower lumbar segmental artery active bleeding was stopped. One month after discharge, the abdominal hematoma was gradually absorbed, and the pain in the waist, leg, and abdomen disappeared.
Symptoms such as abdominal pain, abdominal distension, and exacerbation of lower limb pain, may suggest the occurrence of psoas hematoma after PLIF. DSA vascular embolization is suggested as the first treatment approach for this type of complication.
腰椎体滑脱患者行后路腰椎间融合术(PLIF)后发生腰大肌血肿较为罕见。
我们在此报告 1 例 57 岁男性患者,诊断为腰椎滑脱,在当地医院行 PLIF 手术。术后 7 天出现腹痛,右下肢疼痛逐渐加重。计算机断层扫描(CT)显示腰大肌周围形成血肿。数字减影血管造影(DSA)提示血管损伤,第 4 腰椎节段右侧节段动脉破裂。患者随后接受 DSA 血管栓塞治疗,术后腰椎节段动脉活动性出血停止。出院后 1 个月,腹部血肿逐渐吸收,腰部、腿部和腹部疼痛消失。
PLIF 后出现腹痛、腹胀和下肢疼痛加重等症状,可能提示发生腰大肌血肿。DSA 血管栓塞治疗建议作为该类并发症的首选治疗方法。