Abstract:
Objective To explore the clinical characteristics and physiotherapy for the Chinese hemophilia patients with femoral nerve injury due to illiopsoas bleeding.
Methods Thirty-four hemophilia patients with femoral nerve injury due to illiopsoas bleeding who had been treated in Peking Union Medical College Hospital between January 2006 and December 2010 were enrolled. The comprehensive treatment included factor replacement, joint protection and weight-bearing exercise, proprioception training, neurotrophic drugs, neuromuscular electronic stimulation, pulsed magnetic field, and low-intensity laser. The clinical characteristics including age distribution, clinical manifestations, complications, ultrasound image, and physiotherapy efficacy were retrospectively analyzed.
Results All the 34 patients were male and their mean age was (17.6±3.3) years. All patients had loss of range of motion in the affected hip, decreased strength on quadriceps and deficiency of superficial sensory in front of thigh. Twenty patients had secondary knee bleeding. Twenty patients accompanied with quadriceps atrophy. Pseudotumor developed in one patient. The main findings of the ultrasound image were low-echo mass in illiopsoas muscles or inguinal region. Thirty-two patients received 8-to 12-week comprehensive physiotherapy under the support of factor replacement. Thirty-one patients regained same range of motion of hip as baseline with hematoma disappeared completely, 27 patients got ≥ 4 grade of quadriceps force, and 12 patients obtained improved superficial sensory function of femoral nerve.
Conclusions In this cohort of femoral nerve injury due to illiopsoas bleeding, most of the patients are adolescent. The high prevalence of secondary knee bleeding is found. Comprehensive physiotherapy under the support of factor replacement is safe and effective for hematoma absorption and neurological function recovery.
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