Guivarc'h M
Service de Chirurgie Viscérale, C.M.C. Foch, Suresnes.
J Chir (Paris). 1997;134(9-10):382-9.
We present 29 cases of haematoma of the iliac psoas muscle, following anticoagulant treatment and review 158 cases so far published. In 60 p. 100 of cases, the anticoagulant was some form of intravenous or subcutaneous heparin; prescribed in 40 p. 100 of cases for venous thrombosis followed rapidly by pulmonary embolism, in half the cases between the 3rd and the 14th day. Hypocoagulation was excessive in 64 p. 100 of the cases. Clinically the onset is marked in all cases by a violent pain in the territory of femoral nerve, anaemia (40 p. 100) psoïtis (32 p. 100) and iliac mass (51 p. 100), ecchymosis (13 p. 100) and particularly 23 among 29 cases an early or late femoral paralysis. The clinical diagnosis has been confirmed by echography 21 cases an or CT scan (7 cases). Our approach has been definitely surgical. The surgical procedure carried out in 20 p. 100 of the cases published, and in 23 of our ones, relieves the pain, provides for an early efficient physiotherapy, and a regression of the femoral paralysis, much more rapidly and completely than in the absence of surgery. The anatomical lesions, and the condition of the femoral nerve are described in the operative records, account for that evolution and explain our position. Traumatic and hemophilic have evocated.
我们报告了29例抗凝治疗后发生的髂腰肌血肿病例，并回顾了迄今为止已发表的158例病例。在60%的病例中，抗凝剂为某种形式的静脉或皮下肝素；在40%的病例中，因静脉血栓形成后迅速发生肺栓塞而使用，其中一半病例发生在第3至14天之间。64%的病例存在过度低凝。临床上，所有病例的起病均以股神经支配区域的剧烈疼痛、贫血（40%）、腰大肌炎（32%）和髂部肿块（51%）、瘀斑（13%）为特征，尤其是29例中有23例出现早期或晚期股神经麻痹。21例通过超声检查或CT扫描（7例）确诊。我们的治疗方法明确为手术治疗。在已发表病例的20%以及我们的23例病例中所实施的手术，比未进行手术时能更快、更完全地缓解疼痛，为早期有效的物理治疗提供条件，并使股神经麻痹消退。手术记录中描述了解剖学病变及股神经状况，解释了这种病情发展并说明了我们的观点。还提及了创伤性和血友病性因素。
