切换至 "中华医学电子期刊资源库"

中华诊断学电子杂志 ›› 2024, Vol. 12 ›› Issue (04) : 245 -248. doi: 10.3877/cma.j.issn.2095-655X.2024.04.006

病例诊断思维

Morel-Lavallée 损伤继发血清肿一例
田峰瑞1, 蒋锦源1, 李阳1, 张连阳1,()   
  1. 1.400042 重庆,陆军军医大学大坪医院战创伤医学中心,创伤与化学中毒全国重点实验室
  • 收稿日期:2024-09-11 出版日期:2024-11-26
  • 通信作者: 张连阳
  • 基金资助:
    陆军军医大学科技创新能力提升专项(2023XLC07)

A case of Morel-Lavallée injury complicated with seroma

Fengrui Tian1, Jinyuan Jiang1, Yang Li1, Lianyan Zhang1,()   

  1. 1.War Trauma Medicine,State Key Laboratory of Trauma and Chemical Poisoning,Daping Hospital,Army Medical University,Chongqing 400042,China
  • Received:2024-09-11 Published:2024-11-26
  • Corresponding author: Lianyan Zhang
引用本文:

田峰瑞, 蒋锦源, 李阳, 张连阳. Morel-Lavallée 损伤继发血清肿一例[J]. 中华诊断学电子杂志, 2024, 12(04): 245-248.

Fengrui Tian, Jinyuan Jiang, Yang Li, Lianyan Zhang. A case of Morel-Lavallée injury complicated with seroma[J]. Chinese Journal of Diagnostics(Electronic Edition), 2024, 12(04): 245-248.

目的

探讨Morel-Lavallée 损伤后血清肿的临床特征和诊治原则。

方法

回顾性分析2024 年8 月19 日大坪医院创伤外科收治的1 例Morel-Lavallée 损伤后并发血清肿患者的临床资料,并进行文献复习。

结果

患者男性,48 岁,于2024 年7 月22 日因重物碾压胸腹受伤。2024 年8 月13 日,患者发现左腹股沟区肿胀并逐渐扩大至左大腿。外院盆腔MRI 和CT 检查显示多处损伤和积液,考虑淋巴漏,横纹肌溶解待排;淋巴显像示左大腿上段内侧至左侧腹股沟区淋巴管积液扩张伴少许积气,周围软组织少许淋巴液渗漏,考虑左侧腹股沟区淋巴管损伤伴回流受阻并渗漏。入院后完善相关检查后留置腹腔引流管及左大腿内侧引流管,并于左大腿处行加压包扎。7 d 后拔除引流管并持续加压包扎,超声检查无积液,患者症状改善明显,未行手术治疗。

结论

Morel-Lavallée 血清肿经常被误诊或诊断不及时,了解Morel-Lavallée 血清肿的诊断和治疗选择至关重要。

Objective

To explore the clinical features,diagnosis and treatment of seroma after Morel-Lavallée injury.

Methods

The clinical data of a patient with seroma after Morel-Lavallée injury treated in the Department of Traumatology,Daping Hospital on August 19,2024 were analyzed retrospectively,and the literature was reviewed.

Results

The patient,a 48-year-old male,was injured on July 22,2024 by a heavy object crushing his chest and abdomen.On August 13,2024,the patient found swelling in the left inguinal area and gradually extended to the left thigh.Pelvic magnetic resonance imaging and CT examination in the outside hospital showed multiple injuries and effusion,suggesting lymphatic leakage,with rhabdomyolysis to be excreted.Lymphography showed lymphatic effusion from the left upper thigh to the left inguinal region,with minor gas and lymphatic leakage observed around the soft tissue,considering lymphatic vessels injury in the left inguinal region with reflux obstruction and leakage.Following the necessary examinations upon admission,the abdominal drainage tube and the left inner thigh drainage tube were retained,and the left thigh was bandaged with pressure.After 7 days,the drainage tube was removed and bandaged under continuous pressure.There was no effusion in ultrasonic examination,and the patient's symptoms were obviously improved without surgical treatment.

Conclusions

Morel-Lavallée seroma is often misdiagnosed or diagnosed late.Therefore,a thorough understanding of the diagnosis and treatment of Morel-Lavallée seroma is crucial.

图1 Morel-Lavallée 损伤合并血清肿患者淋巴显像 注:左大腿上段内侧存在淋巴漏,考虑有淋巴管损伤(箭头所示)
图2 Morel-Lavallée 损伤合并血清肿患者增强CT 图像 注:a、b、c 图分别为矢状位、轴位、冠状位,示患者损伤部位,可见左侧腹股沟及左大腿内侧有积液(箭头所示)
[1]
Singh R,Rymer B,Youssef B,et al.The Morel-Lavallée lesion and its management:a review of the literature[J].J Orthop,2018,15(4):917-921.DOI:10.1016/j.jor.2018.08.032.
[2]
Fabro E,Costa RM,Fernandes MC,et al.Seroma incidence and risk factors in women undergoing mastectomies as surgical breast cancer treatment[J].Support Care Cancer,2024,32(10):688.DOI:10.1007/s00520-024-08881-w.
[3]
Ge Y,Zhou Y,Liu J,et al.A nomogram prediction model for postoperative seroma/hematoma in elderly subjects after TAPP[J].Hernia,2024,28(5):1961-1967.DOI:10.1007/s10029-024-03134-5.
[4]
Haydon N,Zoumaras J.Surgical management of morel-lavallee lesion[J].Eplasty,2015 (15):ic14.
[5]
Nair AV,Nazar P,Sekhar R,et al.Morel-Lavallée lesion:a closed degloving injury that requires real attention[J].Indian J Radiol Imaging,2014,24 (3): 288-290.DOI: 10.4103/0971-3026.137053.
[6]
de Pablo Márquez B,Serra Gallego M,González Chavero D,et al.Morel-Lavallée seroma[J].Semergen,2014,40(6):350-351.DOI:10.1016/j.semerg.2013.11.004.
[7]
Yang Y,Tang TT.The Morel-Lavallée lesion:review and update on diagnosis and management[J].Orthop Surg,2023,15(10):2485-2491.DOI:10.1111/os.13826.
[8]
Gummalla KM,George M,Dutta R.Morel-Lavallee lesion:case report of a rare extensive degloving soft tissue injury[J].Ulus Travma Acil Cerrahi Derg,2014,20(1):63-65.DOI:10.5505/tjtes.2014.88403.
[9]
Molina BJ,Ghazoul EN,Janis JE.Practical review of the comprehensive management of Morel-Lavallée lesions[J].Plast Reconstr Surg Glob Open,2021,9(10):e3850.DOI:10.1097/GOX.0000000000003850.
[10]
Jones RM,Hart AM.Surgical treatment of a Morel-Lavallée lesion of the distal thigh with the use of lymphatic mapping and fibrin sealant[J].J Plast Reconstr Aesthet Surg,2012,65(11):1589-1591.DOI:10.1016/j.bjps.2012.03.046.
[11]
Tejwani SG,Cohen SB,Bradley JP.Management of Morel-Lavallee lesion of the knee:twenty-seven cases in the national football league[J].Am J Sports Med,2007,35(7):1162-1167.DOI:10.1177/0363546507299448.
[12]
Bansal A,Bhatia N,Singh A,et al.Doxycycline sclerodesis as a treatment option for persistent Morel-Lavallée lesions[J].Injury,2013,44(1):66-69.DOI:10.1016/j.injury.2011.11.024.
[13]
Bonilla-Yoon I,Masih S,Patel DB,et al.The Morel-Lavallée lesion:pathophysiology,clinical presentation,imaging features,and treatment options[J].Emerg Radiol,2014,21(1):35-43.DOI:10.1007/s10140-013-1151-7.
[14]
Dodwad SN,Niedermeier SR,Yu E,et al.The Morel-Lavallée lesion revisited:management in spinopelvic dissociation[J].Spine J,2015,15(6):e45-51.DOI:10.1016/j.spinee.2013.08.023.
[15]
Shen C,Peng JP,Chen XD.Efficacy of treatment in peri-pelvic Morel-Lavallee lesion:a systematic review of the literature[J].Arch Orthop Trauma Surg,2013,133(5):635-640.DOI:10.1007/s00402-013-1703-z.
[16]
Eldenburg E,Pfaffenberger M,Gabriel A.Closure of a complex lower extremity wound with the use of multiple negative pressure therapy modalities[J].Cureus,2020,12(7):e9247.DOI:10.7759/cureus.9247.
[17]
Nickerson TP,Zielinski MD,Jenkins DH,et al.The Mayo Clinic experience with Morel-Lavallée lesions:establishment of a practice management guideline[J].J Trauma Acute Care Surg,2014,76(2):493-497.DOI:10.1097/TA.0000000000000111.
[18]
Kage T,Hirota J,Yamamoto N,et al.Arthroscopic treatment for Morel-Lavallée lesion of the thigh:a case report and literature review[J].Int J Surg Case Rep,2021(78):58-61.DOI:10.1016/j.ijscr.2020.11.160.
[19]
Vanhegan IS,Dala-Ali B,Verhelst L,et al.The Morel-Lavallée lesion as a rare differential diagnosis for recalcitrant bursitis of the knee:case report and literature review[J].Case Rep Orthop,2012(2012):593193.DOI:10.1155/2012/593193.
[20]
Luria S,Applbaum Y,Weil Y,et al.Talc sclerodhesis of persistent Morel-Lavallée lesions (posttraumatic pseudocysts):case report of 4 patients[J].J Orthop Trauma,2006,20(6):435-438.DOI:10.1097/00005131-200607000-00013.
[21]
Penaud A,Quignon R,Danin A,et al.Alcohol sclerodhesis: an innovative treatment for chronic Morel-Lavallée lesions[J].J Plast Reconstr Aesthet Surg,2011,64(10):e262-264.DOI:10.1016/j.bjps.2011.06.012.
[22]
Carlson DA,Simmons J,Sando W,et al.Morel-lavalée lesions treated with debridement and meticulous dead space closure: surgical technique[J].J Orthop Trauma,2007,21(2):140-144.DOI:10.1097/BOT.0b013e31802f19ca.
[23]
Norman G,Shi C,Goh EL,et al.Negative pressure wound therapy for surgical wounds healing by primary closure[J].Cochrane Database Syst Rev,2022,4 (4): CD009261.DOI:10.1002/14651858.CD009261.pub7.
[1] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[2] 熊鹰, 林敬莱, 白奇, 郭剑明, 王烁. 肾癌自动化病理诊断:AI离临床还有多远?[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 535-540.
[3] 石海波, 赵旭东, 王聪, 曲巍. 气肿性肾盂肾炎、气肿性膀胱炎并脓毒性休克一例报道并文献复习[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 644-647.
[4] 林逸, 钟文龙, 李锴文, 何旺, 林天歆. 广东省医学会泌尿外科疑难病例多学科会诊(第15期)——转移性膀胱癌的综合治疗[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 648-652.
[5] 公宇, 廖媛, 尚梅. 肝细胞癌TACE术后复发影响因素及预测模型建立[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 818-824.
[6] 李一帆, 朱帝文, 任伟新, 鲍应军, 顾俊鹏, 张海潇, 曹耿飞, 阿斯哈尔·哈斯木, 纪卫政. 血GP73水平在原发性肝癌TACE疗效评价中的作用[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 825-830.
[7] 魏志鸿, 刘建勇, 吴小雅, 杨芳, 吕立志, 江艺, 蔡秋程. 肝移植术后急性移植物抗宿主病的诊治(附四例报告)[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 846-851.
[8] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[9] 陈伟杰, 何小东. 胆囊癌免疫靶向治疗进展[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 763-768.
[10] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[11] 王秋生. 胆道良性疾病诊疗策略[J]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 779-782.
[12] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
[13] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
[14] 王子阳, 王宏宾, 刘晓旌. 血清标志物对甲胎蛋白阴性肝细胞癌诊断的研究进展[J]. 中华临床医师杂志(电子版), 2024, 18(07): 677-681.
[15] 陈慧, 邹祖鹏, 周田田, 张艺丹, 张海萍. 皮肤镜对头皮红斑性皮肤病辅助鉴别诊断的研究进展[J]. 中华临床医师杂志(电子版), 2024, 18(07): 692-698.
阅读次数
全文


摘要