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血管栓塞联合截肢治疗复发性血友病性假肿瘤。

Vascular embolization combined with amputation for recurrent hemophilic pseudotumor.

作者信息

Lv Shuaijie, Chen Lei, Tang Yi, Gong Yichen, Tong Peijian, Guo Jiayi, Zhang Zhongyi

机构信息

The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Youdian Road, Shangcheng District, Hangzhou City, Zhejiang Province, China.

Luoyang Orthopedic-Traumatological Hospital of Hehan Province (Henan Provincial Orthopedic Hospital), No. 82, Qiming South Road, Chanhe Hui District, Henan, Luoyang, China.

出版信息

BMC Musculoskelet Disord. 2025 Aug 11;26(1):775. doi: 10.1186/s12891-025-09031-x.

DOI:10.1186/s12891-025-09031-x
PMID:40790182
Abstract

Hemophilic pseudotumor is a rare, life - threatening complication of hemophilia. Surgical treatment presents substantial challenges, particularly in coagulation management, perioperative wound healing, and infection control. We present a case of recurrent pseudotumor with refractory wound healing following multiple surgical interventions, which was successfully managed through a multidisciplinary approach combining vascular embolization with amputation. The case involves a 28-year-old male patient with hemophilia-associated pseudotumor who presented with a two-year history of impaired wound healing following right above-knee amputation. Clinical examination revealed significant swelling and tenderness in the right thigh region, accompanied by persistent drainage of black viscous exudate from the surgical site. Due to pseudotumor recurrence and chronic wound complications, a multidisciplinary team comprising hematology, interventional radiology, and orthopedic specialists implemented a combined therapeutic strategy of preoperative vascular embolization followed by definitive amputation. The postoperative course demonstrated favorable outcomes, with complete wound healing and no evidence of disease recurrence during the 6-month follow-up observation period.

摘要

血友病性假肿瘤是血友病一种罕见的、危及生命的并发症。手术治疗面临重大挑战,尤其是在凝血管理、围手术期伤口愈合和感染控制方面。我们报告一例在多次手术干预后出现复发性假肿瘤且伤口愈合困难的病例,通过血管栓塞与截肢相结合的多学科方法成功进行了处理。该病例涉及一名28岁男性血友病相关假肿瘤患者,其右膝上截肢后伤口愈合不良已有两年病史。临床检查发现右大腿区域明显肿胀和压痛,手术部位持续有黑色粘性渗出物引流。由于假肿瘤复发和慢性伤口并发症,由血液学、介入放射学和骨科专家组成的多学科团队实施了术前血管栓塞然后进行确定性截肢的联合治疗策略。术后过程显示出良好的结果,伤口完全愈合,在6个月的随访观察期内无疾病复发迹象。

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1
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本文引用的文献

1
The evolution of physiotherapy in the multidisciplinary management of persons with haemophilia (PWH): A scoping review.物理治疗在血友病患者(PWH)多学科管理中的演变:范围综述。
Haemophilia. 2023 Jan;29(1):11-20. doi: 10.1111/hae.14661. Epub 2022 Sep 27.
2
Risk Factors for Amputation in the Surgical Treatment of Hemophilic Osteoarthropathy: A 20-Year Single-Center Report.血友病性骨关节炎外科治疗中截肢的危险因素:一项20年单中心报告
Pain Res Manag. 2022 Mar 28;2022:1512616. doi: 10.1155/2022/1512616. eCollection 2022.
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Effectiveness of rehabilitation on pain and function in people affected by hemophilia.
康复治疗对血友病患者疼痛和功能的影响。
Medicine (Baltimore). 2021 Dec 17;100(50):e27863. doi: 10.1097/MD.0000000000027863.
4
Outcome of Surgical Management of Hemophilic Pseudotumor: Review of 10 Cases from Single-Center.血友病性假瘤手术治疗的结果:单中心 10 例回顾性研究。
Orthop Surg. 2022 Jan;14(1):27-34. doi: 10.1111/os.13174. Epub 2021 Nov 28.
5
Surgical treatment for patients with hemophilic pseudotumor-related femoral fracture: a retrospective study.血友病性假瘤相关股骨干骨折患者的外科治疗:一项回顾性研究。
J Orthop Surg Res. 2021 Apr 21;16(1):275. doi: 10.1186/s13018-021-02426-1.
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Pre-operative rehabilitation in lower-limb amputation patients and its effect on post-operative outcomes.下肢截肢患者的术前康复及其对术后结局的影响。
Med Hypotheses. 2020 Oct;143:110134. doi: 10.1016/j.mehy.2020.110134. Epub 2020 Jul 26.
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Various Surgical Treatment of Hemophilic Pseudotumor : A Case Series.血友病性假肿瘤的多种手术治疗:病例系列
Arch Bone Jt Surg. 2019 Nov;7(6):514-522.
8
Effectiveness of an Evidence-Based Amputee Rehabilitation Program: A Pilot Randomized Controlled Trial.基于证据的截肢康复计划的有效性:一项试点随机对照试验。
Phys Ther. 2020 May 18;100(5):773-787. doi: 10.1093/ptj/pzaa008.
9
Characteristics and management of the haemophilia-associated pseudotumours.血友病相关性假性肿瘤的特征和处理。
Haemophilia. 2020 Jan;26(1):33-40. doi: 10.1111/hae.13870. Epub 2019 Nov 19.
10
Does Rehabilitation before Total Knee Arthroplasty Benefit Postoperative Recovery? A Systematic Review.全膝关节置换术前康复是否有益于术后恢复?一项系统评价。
Indian J Orthop. 2019 Jan-Feb;53(1):138-147. doi: 10.4103/ortho.IJOrtho_643_17.