Aronstam A, Browne R S, Wassef M, Hamad Z
J Bone Joint Surg Br. 1983 Jan;65(1):19-23. doi: 10.1302/0301-620X.65B1.6401743.
The clinical features, management and outcome of 178 early bleeding episodes into the musculature of the thigh and lower limb of 37 severe haemophiliacs are reported. Ninety-five per cent of all bleeds were treated in under three hours from onset of symptoms and the mean time to complete restoration of function was 3.5 days. The most frequent site of bleeding was the quadriceps (44 per cent) followed by the calf (35 per cent), anterior tibial compartment (seven per cent), adductors of the thigh (seven per cent), hamstrings (six per cent) and sartorius (one per cent). Bleeds of the quadriceps took longest to resolve (mean, four days), significantly longer than bleeds of the calf muscle (3.1 days). The first symptom in 66 per cent of bleeds was pain on movement. When the quadriceps was involved, this rapidly progressed to pain at rest. There was a significant prolongation of recovery time when bleeds of this muscle group were treated more than two hours after the onset of symptoms. Bleeds of the calf muscle required less transfusions and no prolongation in recovery time occurred in bleeds treated up to three hours from the onset of symptoms. The results of this study contrast markedly with earlier reports based on later presentations.
报告了37例严重血友病患者大腿和下肢肌肉组织早期178次出血发作的临床特征、治疗方法及结果。所有出血事件中有95%在症状出现后三小时内得到治疗，功能完全恢复的平均时间为3.5天。最常见的出血部位是股四头肌（44%），其次是小腿（35%）、胫前肌间隔（7%）、大腿内收肌（7%）、腘绳肌（6%）和缝匠肌（1%）。股四头肌出血的消退时间最长（平均4天），明显长于小腿肌肉出血（3.1天）。66%的出血事件首发症状为活动时疼痛。当股四头肌受累时，疼痛会迅速发展为静息痛。若在症状出现两小时后才治疗该肌群出血，恢复时间会显著延长。小腿肌肉出血所需输注量较少，在症状出现后三小时内治疗的出血事件恢复时间未延长。本研究结果与早期基于较晚就诊情况的报告形成显著对比。
