Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA.
BMJ Case Rep. 2021 Jan 18;14(1):e239024. doi: 10.1136/bcr-2020-239024.
We report the case of a 68-year-old man who was placed on heparin as bridge therapy and subsequently developed an iliacus haematoma with associated femoral nerve palsy. His team involved the orthopaedic surgery team in delayed fashion after his symptom onset. Due to his active medical conditions, he did not undergo surgical decompression of his haematoma until late into his hospital course. Unfortunately, this patient did not regain meaningful function from his femoral nerve deficit. We believe this case highlights the high index of suspicion necessary for making this diagnosis as well as the repercussions of an untimely decompression for this acute, compressive neuropathy. Although we are surgeons and this is a surgical case, we hope to publish this case in a medical journal to raise awareness that surgical decompression does have a role in this diagnosis and should ultimately be pursued early in its course for optimal patient benefit.
我们报告了一例 68 岁男性患者,他接受肝素桥接治疗,随后出现髂腰肌血肿,并伴有股神经麻痹。他的团队在症状出现后延迟请骨科手术团队参与治疗。由于他的病情活跃,直到住院后期他才接受血肿的手术减压。不幸的是,该患者的股神经缺损未能恢复到有意义的功能。我们认为,该病例突出了对这种诊断进行高度怀疑的必要性,以及这种急性压迫性神经病的减压不及时所带来的后果。尽管我们是外科医生,这是一个外科病例,但我们希望在医学杂志上发表这个病例,以提高认识,即手术减压确实在这个诊断中发挥作用,并且应该在其病程的早期尽早进行,以获得最佳的患者受益。