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多发伤中与横纹肌溶解相关的莫雷尔-拉瓦利损伤

Morel-Lavallee Lesion Associated With Rhabdomyolysis in Polytrauma.

作者信息

Mudiganti V N K Srinivas, Singam Amol Prakash, Kakara Sneha, Iswarya Mudiganti Raja Sri Jaya, Jain Abhishek

机构信息

Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.

Cardiology, Krishna Institute of Medical Sciences (KIMS), Rajahmundry, IND.

出版信息

Cureus. 2024 Jun 30;16(6):e63536. doi: 10.7759/cureus.63536. eCollection 2024 Jun.

DOI:10.7759/cureus.63536
PMID:39086784
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11290411/
Abstract

We describe the case of a 30-year-old man who allegedly had a history of road traffic accidents. While walking on the road, he was hit by a truck. He presented with complaints of facial injuries and being unable to move his right lower limb. On examination, there is a 15x4 cm lacerated wound in the perineal area, with left testes exposed; anal tone could not be assessed; the right lower limb is externally rotated; and deformity is present with palpable peripheral pulses. He was diagnosed with a right sacral ala fracture, a distal one-third shaft of the right tibia fracture, and a right suprapubic rami fracture. Ultrasound of the right thigh showed hematoma and subcutaneous edema all around the gluteal and inguinal regions and fluid collection in the right inguinal region, which is suggestive of Morel-Lavallee lesion (MLL) type 6. On day two of admission, urine was dark in color, and creatinine kinase was elevated, which is suggestive of rhabdomyolysis. He was managed with hydration, electrolyte correction for rhabdomyolysis, and wound debridement for MLL apart from perineal injury, right sacral ala fracture, right suprapubic rami fracture, and distal one-third shaft of the right tibia fracture, with perineal repair and loop colostomy, pelvic binder, and external fixator, respectively. Early identification of the MLL associated with rhabdomyolysis in this polytrauma patient led to recovery and a successful outcome.

摘要

我们描述了一名30岁男性的病例,据称他有道路交通事故史。他在路上行走时被一辆卡车撞倒。他因面部受伤和右下肢无法活动前来就诊。检查发现,会阴区有一处15×4厘米的撕裂伤,左侧睾丸外露;无法评估肛门张力;右下肢外旋;有畸形,但可触及外周脉搏。他被诊断为右侧骶骨翼骨折、右胫骨远端三分之一骨干骨折和右侧耻骨上支骨折。右大腿超声显示臀区和腹股沟区周围有血肿和皮下水肿,右侧腹股沟区有液体积聚,提示为6型莫雷尔-拉瓦利损伤(MLL)。入院第二天,尿液颜色变深,肌酸激酶升高,提示横纹肌溶解。除了会阴损伤、右侧骶骨翼骨折、右侧耻骨上支骨折和右胫骨远端三分之一骨干骨折外,针对横纹肌溶解给予补液、纠正电解质,针对MLL进行伤口清创,分别进行会阴修复和袢式结肠造口术、骨盆固定带固定和外固定架固定。在这名多发伤患者中,早期识别与横纹肌溶解相关的MLL,使其康复并获得了成功的治疗结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/b7b8e2847110/cureus-0016-00000063536-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/99d20db41683/cureus-0016-00000063536-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/7075c4f1732b/cureus-0016-00000063536-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/537277c70a0c/cureus-0016-00000063536-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/71a59eb47b5e/cureus-0016-00000063536-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/2c0881dcf64d/cureus-0016-00000063536-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/2f17164c09ce/cureus-0016-00000063536-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/81ef499f8bba/cureus-0016-00000063536-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/b7b8e2847110/cureus-0016-00000063536-i08.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/99d20db41683/cureus-0016-00000063536-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/7075c4f1732b/cureus-0016-00000063536-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/537277c70a0c/cureus-0016-00000063536-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/71a59eb47b5e/cureus-0016-00000063536-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/2c0881dcf64d/cureus-0016-00000063536-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/2f17164c09ce/cureus-0016-00000063536-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/81ef499f8bba/cureus-0016-00000063536-i07.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/111e/11290411/b7b8e2847110/cureus-0016-00000063536-i08.jpg

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本文引用的文献

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Morel-Lavallée Lesion: Uncommon Injury often Missed.莫雷尔-拉瓦利埃损伤:一种常被漏诊的罕见损伤。
J Orthop Case Rep. 2022 Oct;12(10):57-60. doi: 10.13107/jocr.2022.v12.i10.3366.
2
Morel-Lavallee Lesion: A Case of Lower Extremity Internal Degloving Injury.莫雷尔-拉瓦利损伤:一例下肢内部脱套伤病例
Cureus. 2023 Jan 20;15(1):e33994. doi: 10.7759/cureus.33994. eCollection 2023 Jan.
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Case report: Rhabdomyolysis and kidney injury in a statin-treated hypothyroid patient-kill two birds with one stone.病例报告:他汀类药物治疗的甲状腺功能减退患者发生横纹肌溶解和肾损伤——一石二鸟。 (此译文根据文本字面意思翻译,但从医学角度来说,“一石二鸟”在此语境不太符合准确含义,推测原文可能想表达的是类似“一种情况引发了两种不良后果”之类的意思,具体准确理解需结合更完整的医学背景。) 括号内为补充说明,非翻译内容。 仅按照要求翻译为:病例报告:他汀类药物治疗的甲状腺功能减退患者发生横纹肌溶解和肾损伤——一石二鸟。
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J Belg Soc Radiol. 2017 Dec 16;101(Suppl 2):15. doi: 10.5334/jbr-btr.1401.
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Leadership and Teamwork in Trauma and Resuscitation.创伤与复苏中的领导力与团队协作
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