Shi Guan, Zhang Liang, Chen Hao, Su Tianhao, Jia Pu, Feng Fei, Chen Mengmeng, Bao Li
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Geriatr Orthop Surg Rehabil. 2023 Feb 12;14:21514593231158277. doi: 10.1177/21514593231158277. eCollection 2023.
This article introduced the management of a case with severe left lower extremity pain and forced hip flexion after posterior lumbar interbody fusion and a final diagnosis of left psoas hematoma.
Here we reported a case of a 65-year-old female received posterior lumbar interbody fusion (PLIF) for L4-L5 spondylolisthesis and L4 instability. On the postoperative day one, the hemoglobin level decreased from 108 g/L to 78 g/L. Meanwhile, the patient presented low back pain and inner thigh radiating pain (VAS pain scale = 8). The pain was so severe that it could be barely relieved by keeping left hip in flexion position. On the postoperative day 6, the pain was still severe even after taking mecobalamin, ankylosaurus, dehydrant agents and central pain relievers(VAS pain scale = 9). Computed Tomography indicated a left intramuscular hematoma image extending down to the left iliac fossa. Active hemorrhage of lumbar segmental arterial was detected by B-ultrasound. The patient then received vascular embolization under angiography on the postoperative day 7.
The pain in the low back and inner thigh were significantly relieved after the procedure (VAS3-4). On the postoperative day nineteen, the left hip can be fully extended, but the patient was still not able to stand on left leg without a walking stick. On the postoperative day 27, she was able to walk independently.
The main reason for the complication was the second conical dilation channel slipped and entered the lateral side of the vertebral body along the transverse process. After timely embolization, pain was significantly relieved and muscle strength was improved.
Angiographic embolization is an effective treatment for psoas hematoma after posterior lumbar interbody fusion.
本文介绍了一例腰椎后路椎间融合术后出现严重左下肢疼痛及强迫性髋关节屈曲病例的处理过程，最终诊断为左腰大肌血肿。
我们报告了一例65岁女性，因L4 - L5椎体滑脱和L4椎体不稳接受腰椎后路椎间融合术（PLIF）。术后第1天，血红蛋白水平从108 g/L降至78 g/L。同时，患者出现腰痛及大腿内侧放射痛（视觉模拟评分法疼痛评分=8）。疼痛非常严重，即使保持左髋关节屈曲位也难以缓解。术后第6天，即使服用甲钴胺、强骨龙、脱水剂及中枢性镇痛药后疼痛仍很严重（视觉模拟评分法疼痛评分=9）。计算机断层扫描显示左侧肌内血肿影像向下延伸至左髂窝。B超检查发现腰段动脉有活动性出血。患者于术后第7天在血管造影下行血管栓塞术。
术后腰痛及大腿内侧疼痛明显缓解（视觉模拟评分法评分3 - 4）。术后第19天，左髋关节可完全伸直，但患者仍无法独立站立，需借助拐杖。术后第27天，她能够独立行走。
并发症的主要原因是第二个锥形扩张通道滑脱并沿横突进入椎体侧面。及时栓塞后，疼痛明显缓解，肌力改善。
血管造影栓塞术是治疗腰椎后路椎间融合术后腰大肌血肿的有效方法。
