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腰椎后路融合手术后自发性腰大肌血肿:一项小型文献综述

Spontaneous psoas hematoma following posterior lumbar fusion surgery: a mini literature review.

作者信息

Zhao Hai-Hong, Guo You-Feng, Zhang Shu-Bao, Xu Hao-Wei, Yu Bin, Gu Hui-Da, Wang Shan-Jin, Hu Tao, Wu De-Sheng

机构信息

Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.

Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.

出版信息

BMC Musculoskelet Disord. 2025 Mar 12;26(1):244. doi: 10.1186/s12891-025-08455-9.

Abstract

BACKGROUND

Spontaneous psoas hematoma is a very rare clinical entity, and the pathogenesis and pathologic mechanisms of spontaneous psoas hematoma remain unclear, thus, it is of great value to explore.

CASE PRESENTATION

We encountered a patient who developed femoral nerve paralysis due to psoas muscle hematoma following posterior lumbar fusion surgery. A 69-year-old female with lumbar spinal canal stenosis underwent posterior lumbar fusion at the L3-4 and L4-5 levels. On the 7th postoperative day, the patient complained of severe abdominal pain along with right limb pain and weakness. A computed tomography image showed a large acute psoas muscle hematoma on the right side. After conservative treatment, the psoas hematoma was resolved and the patient's femoral nerve paralysis gradually recovered.

CONCLUSIONS

Spontaneous psoas hematoma is a rare and extremely dangerous complication after lumbar spine surgery. For high - risk patients who have taken anticoagulants before the operation, we must be vigilant against the occurrence of this complication.

摘要

背景

自发性腰大肌血肿是一种非常罕见的临床病症,其发病机制和病理机制尚不清楚,因此,对其进行探索具有重要价值。

病例报告

我们遇到一名患者,其在腰椎后路融合手术后因腰大肌血肿导致股神经麻痹。一名69岁女性因腰椎管狭窄症在L3 - 4和L4 - 5节段接受了腰椎后路融合手术。术后第7天,患者主诉严重腹痛伴右下肢疼痛和无力。计算机断层扫描图像显示右侧有巨大急性腰大肌血肿。经过保守治疗,腰大肌血肿消退,患者的股神经麻痹逐渐恢复。

结论

自发性腰大肌血肿是腰椎手术后一种罕见且极其危险的并发症。对于术前服用抗凝剂的高危患者,我们必须警惕这种并发症的发生。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/963d/11900023/30e7d7203a11/12891_2025_8455_Fig1_HTML.jpg

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