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El absceso del psoas es una enfermedad infecciosa infrecuente y de difícil diagnóstico, caracterizado por una colección purulenta a nivel de este músculo, que provoca un síndrome de respuesta inflamatoria sistémica. La infección puede ser primaria por diseminación hematógena, o secundaria, a partir de un foco infeccioso cercano. Su presentación durante el embarazo es rara, y predomina la forma primaria, razón por la cual se decidió realizar este artículo. Se presenta el caso de una gestante con 28,4 semanas de edad gestacional que ingresó por dolor inguinal con posterior irradiación a la cadera, flanco y región lumbar derechos; postura en flexión de la cadera derecha y marcha antiálgica, así como aparición, a los nueve días de iniciados los síntomas, de una masa dolorosa entre fosa ilíaca y flanco derechos. Los hallazgos de la ecografía abdominal y la resonancia permitieron el diagnóstico de un plastrón apendicular con un apéndice retrocecal, así como absceso del psoas derecho, los cuales se trataron con antibioticoterapia y drenaje percutáneo del absceso, con resultados satisfactorios. El absceso del psoas secundario puede constituir el debut de una apendicitis atípica retrocecal, y para su diagnóstico hay que tener un alto nivel de sospecha por su clínica inespecífica.
The psoas abscess is a rare infectious disease that is difficult to diagnose, characterized by a purulent collection at the level of this muscle, which causes a systemic inflammatory response syndrome. The infection can be primary by hematogenous dissemination, or secondary, from a nearby infectious focus. Its presentation during pregnancy is rare, and the primary form predominates, which is why it was decided to write this article. The case of a pregnant woman with a gestational age of 28.4 weeks who was admitted due to inguinal pain with subsequent irradiation to the right hip, flank, and lumbar region; flexed posture of the right hip and analgesic gait, as well as the appearance, nine days after the onset of symptoms, of a painful mass between the right iliac fossa and flank it is presented. The findings of the abdominal ultrasound and MRI allowed the diagnosis of an appendiceal plastron with a retrocecal appendix, as well as a right psoas abscess, which were treated with antibiotic therapy and percutaneous drainage of the abscess, with satisfactory results. Secondary psoas abscess may constitute the debut of atypical retrocecal appendicitis, and its diagnosis requires a high level of suspicion due to its non-specific symptoms.
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Chronic injury of lumbar back muscles characterized by a high incidence, insidious onset, recurrence and continuous progression is mostly due to unreasonable physical exercise, excessive professional training and unhealthy lifestyle. Persistent or recurrent back pain is the primary clinical manifestations in the early stage. With the prolongation of the injury, the accelerated degeneration of the lumbar back muscle impairs the function and leads to the deterioration of the local and overall mechanical environment of the spine, followed by a series of degenerative spinal diseases such as lumbar disc herniation, lumbar spondylolisthesis, lumbar segmental instability and spinal deformity, which seriously affects the motor function, work and quality of life. However, there is an urgent need to improve the level of awareness and attention to chronic injury and degenerative changes of lumbar back muscles in clinical practice, so as to achieve accurate diagnosis and early intervention of chronic injury of lumbar back muscles. Therefore, the author reviews the etiology, clinical manifestation, diagnosis and treatment of chronic injury of low back muscles to discuss the current problems and summarize the cutting-edge technology, hoping to provide a reference for improving the diagnosis and treatment level of clinicians.
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Objective:To investigate the clinical efficacy of thunder-fire moxibustion combined with external application of Chinese herbal ointment at the trigger point on lumbodorsal myofascial pain syndrome of cold-damp stagnation type.Methods:A total of 90 patients with lumbodorsal myofascial pain syndrome of cold-damp stagnation type admitted to Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine from September 2021 to April 2022 were included in this study. They were randomly divided into three groups ( n = 30/group) using the random number table method. Patients in the Chinese herbal ointment group were treated by external application of Chinese herbal ointment at the trigger point. Patients in the thunder-fire moxibustion group were treated with thunder-fire moxibustion. Patients in the combined therapy group were treated with thunder-fire moxibustion combined with external application of Chinese herbal ointment at the trigger point. All patients were treated for 28 consecutive days. Clinical efficacy was compared among the three groups. Before and after treatment, the Visual Analogue Scale score, local tenderness score, Oswestry Disability Index score and Pittsburgh Sleep Quality Index score were compared among the three groups. Results:Total response rate (96.67%) in the combined therapy group was significantly higher than 73.33% in the thunder-fire moxibustion group and 66.67% in the Chinese herbal ointment group ( χ2 = 9.01, 4.70, both P < 0.05). Visual Analogue Scale score and local tenderness score in the combined therapy group were (1.96 ± 0.93) points and (1.00 ± 0.69) points, respectively, which were significantly lower than (2.43 ± 0.87) points and (1.37 ± 0.56) points in the thunder-fire moxibustion group and (2.77 ± 0.86) points and (1.50 ± 0.57) points in the Chinese herbal ointment group ( F = 6.22, 5.38, both P < 0.05). The Oswestry Disability Index score in the combined therapy group was (19.80 ± 3.80) points, which was significantly lower than (22.30 ± 2.82) points in the thunder-fire moxibustion group and (23.60 ± 3.71) points in the Chinese herbal ointment group ( F = 9.07, both P < 0.05). After treatment, the Pittsburgh Sleep Quality Index score in the combined therapy group was (5.30 ± 1.12) points, which was significantly lower than (6.50 ± 1.33) points in the thunder-fire moxibustion group and (6.73 ± 1.41) points in the Chinese herbal ointment group ( F = 10.59, both P < 0.05). Conclusion:Thunder-fire moxibustion combined with external application of Chinese herbal ointment at the trigger point is highly effective on lumbodorsal myofascial pain syndrome of cold-damp stagnation type than monotherapy. The combined therapy can markedly reduce pain and greatly improve lumbodorsal function and sleep quality.
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ABSTRACT Introduction: This study describes the imaging characteristics and accessibility of the L4 / L5 left oblique corridor used in the OLIF spinal fusion approach and the dimensions of the left oblique corridor at L2/L3 and L3/L4. Methods: Observational, retrospective, and descriptive study, in which MRI is described for 330 patients. The length of the left OC L2/L3, L3/L4, and L4/L5 were measured and classified into four grades: 0 (not measurable), 1 (≤10 mm), 2 (10-20 mm), and 3 (≥20 mm). The psoas was measured at the level of the L4 / L5, and the modified Moro classification was used for the height of the psoas, considering high psoas from AII to AIV. The data was processed in the SPSS 26.0 system. Results: The mean age was 62.1 ± 13.5 years, the OC length in L2/L3, L3/L4 y L4/L5 were 16.1 ± 5.9, 16.2 ± 6.7 and 14.7 ± 8.8 mm, respectively. 14.8% had high psoas. OC grade 0 (2.1%) was obtained in 7 patients, 87 with grade 1 (26.4%), 129 with grade 2 (39.1%), and 107 with grade 3 (32.4%). The length of the OC in males was 2.4 mm (MD, 95% CI: 0.4-4.5, p: 0.02), more than in females. Conclusion: It was shown that 85.2% had an accessible psoas muscle for the left OLIF L4 / L5 approach, 71.5% had an accessible oblique corridor, and only 14.8% had high psoas. These parameters combined, 61.5% of MRI, were appropriate for this approach. Level of evidence III; Retrospective study.
Resumo: Introducción: Este estudio describe las características imagenológicas y la accesibilidad del corredor oblicuo izquierdo L4/L5 utilizado para la fusión intersomática oblicua, así como las dimensiones del corredor oblicuo izquierdo en L2/L3 y L3/L4. Métodos: Estudio observacional, retrospectivo y descriptivo, que se describe la RM de 330 pacientes. Se midió la longitud del CO izquierdo L2/L3, L3/L4 y L4/L5 y se clasificó en cuatro grados: 0 (no medible), 1 (≤10 mm), 2 (10-20 mm) y 3 (≥20 mm). El psoas se midió a nivel de L4/L5, para la altura del psoas se utilizó la clasificación de Moro modificada; considerando psoas alto de AII a AIV. Los datos fueron procesados en el sistema SPSS 26.0. Resultados: La edad media fue de 62.1 ± 13.5 años, la longitud de CO en L2/L3, L3/L4 y L4/L5 fue de 16.1 ± 5.9, 16.2 ± 6.7 y 14.7 ± 8.8 mm, respectivamente. El 14.8% tenía psoas alto. En 7 pacientes, se obtuvo CO grado 0 (2.1%), 87 con grado 1 (26.4%), 129 con grado 2 (39.1%) y 107 con grado 3 (32.4%). La longitud de la CO en hombres fue 2.4 mm (DM, IC 95%: 0.4-4.5, p: 0.02) más que en las mujeres. Conclusão: Se demostró que el 85.2% tenía un psoas accesible para el abordaje OLIF L4/L5 izquierdo, el 71.5% tenía corredor oblicuo accesible y solo el 14.8% tenía psoas alto. Combinados estos parámetros, el 61.5% de las RM fueron apropiadas para este abordaje. Nivel de evidencia III; estudio retrospectivo.
Resumen: Introdução: Este estudo descreve as características de imagem e acessibilidade do corredor oblíquo esquerdo L4/L5 usado para a fusão intersomática oblíqua, bem como as dimensões do corredor oblíquo esquerdo em L2/L3 e L3/L4. Métodos: Estudo observacional e descritivo, no qual é descrita a RM de 330 pacientes. O comprimento do OC esquerdo L2/L3, L3/L4 e L4/L5 foi medido e classificado em quatro graus: 0 (não mensurável), 1 (≤10 mm), 2 (10-20 mm) e 3 (≥20 mm). O psoas foi medido no nível de L4/L5 sendo utilizada a classificação de Moro modificada; considerando um psoas alto de AII a AIV. Os dados foram processados no sistema SPSS 26.0. Resultados: A média de idade foi de 62.1 ± 13.5 anos, o comprimento do CO em L2/L3, L3/L4 e L4/L5 foi de 16.1 ± 5.9, 16.2 ± 6.7 e 14.7 ± 8.8 mm, respectivamente. 14.8% tinham psoas alto. Em 7 pacientes obteve-se CO grau 0 (2.1%), 87 com grau 1 (26.4%), 129 com grau 2 (39.1%) e 107 com grau 3 (32.4%). O comprimento do CO nos homens foi 2.4 mm (MD, IC 95%: 0.4-4.5, p: 0.02) a mais do que nas mulheres. Conclusión: Evidenciou-se que 85.2% tinham psoas acessível para a abordagem OLIF L4/L5 esquerda, 71.5% tinham corredor oblíquo acessível e apenas 14.8% tinham psoas alto. Combinados esses parâmetros, 61.5% das RMs foram adequadas para essa abordagem. Nível de evidência III; Estudo retrospectivo.
Subject(s)
Humans , Male , Female , Spinal Fusion , Magnetic Resonance Spectroscopy , SpineABSTRACT
ABSTRACT Introduction Lumbar muscle strain is a chronic injury to soft tissues such as the lumbar muscles, ligaments, and fascia. Functional exercise has specific applications in treating lumbar muscle injuries caused by sports. However, analyses on the treatment results in the psoas muscle are inconclusive. Objective Analyze the clinical efficacy of functional exercise in treating psoas muscle dysfunction. Methods 10 athletes diagnosed with lumbar muscle strain received continuous training with a functional exercise protocol for two weeks, five times a week. Clinical efficacy was assessed by visual analog scale for pain score and Prokin254 for proprioception ability indices before and after treatment. The article adopts a mathematical statistics analysis method to analyze the therapeutic effect of motor function exercise with SPSS 13.0. Results Patients reported a reduction of pain in the muscles under exertion after functional exercise. The results were significantly different (P<0.05). Patients' lumbar strength was significantly improved. This index has a considerable statistical difference (P<0.05). Conclusion Functional exercise showed a positive effect on the treatment of psoas muscle injury. The research results of this article can provide an effective training protocol for the rehabilitation of people with a psoas muscle strain. Evidence Level II; Therapeutic Studies - Investigating the result.
RESUMO Introdução A tensão muscular lombar é uma lesão crônica dos tecidos moles, tais como músculos lombares, ligamentos e fáscia. O exercício funcional tem certas aplicações no tratamento de lesões musculares lombares ocasionadas pelo esporte. Porém, as análises na intensidade dos resultados do tratamento no músculo psoas são inconclusivas. Objetivo Analisar a eficácia clínica do exercício funcional no tratamento da disfunção no músculo psoas. Métodos 10 atletas com diagnóstico de estiramento muscular lombar receberam treinamento contínuo com protocolo de exercícios funcionais por 2 semanas, 5 vezes por semana. A eficácia clínica foi avaliada pela escala analógica visual de score de dor e Prokin254 para índices de capacidade de propriocepção antes e depois do tratamento. O artigo adota um método de estatística matemática para analisar o efeito terapêutico do exercício da função motora com SPSS 13.0. Resultados Pacientes relataram uma redução da dor na musculatura sob esforço após o exercício funcional. Os resultados foram significativamente diferentes (P<0,05). A força lombar dos pacientes foi significativamente aprimorada. Esse índice tem diferença estatística considerável (P<0,05). Conclusão O exercício funcional revelou um efeito positivo sobre o tratamento da lesão muscular do psoas. Os resultados da pesquisa deste artigo podem fornecer um protocolo eficaz de treinamento para a reabilitação de pessoas com tensão do músculo psoas. Nível de evidência II; Estudos Terapêuticos - Investigação de Resultados.
RESUMEN Introducción La distensión muscular lumbar es una lesión crónica de los tejidos blandos como los músculos lumbares, los ligamentos y la fascia. El ejercicio funcional tiene ciertas aplicaciones en el tratamiento de las lesiones musculares lumbares causadas por el deporte. Sin embargo, los análisis sobre la intensidad de los resultados del tratamiento en el músculo psoas no son concluyentes. Objetivo Analizar la eficacia clínica del ejercicio funcional en el tratamiento de la disfunción del músculo psoas. Métodos 10 atletas con diagnóstico de distensión muscular lumbar recibieron un entrenamiento continuo con un protocolo de ejercicios funcionales durante 2 semanas, 5 veces por semana. La eficacia clínica se evaluó mediante la escala analógica visual para la puntuación del dolor y el Prokin254 para los índices de capacidad de propiocepción antes y después del tratamiento. El artículo adopta un método estadístico matemático para analizar el efecto terapéutico del ejercicio de la función motora con SPSS 13.0. Resultados Los pacientes informaron una reducción del dolor en los músculos bajo esfuerzo después del ejercicio funcional. Los resultados fueron significativamente diferentes (P<0,05). La fuerza lumbar de los pacientes mejoró significativamente. Este índice tiene una diferencia estadística considerable (P<0,05). Conclusión El ejercicio funcional reveló un efecto positivo en el tratamiento de la lesión del músculo psoas. Los resultados de la investigación de este artículo pueden proporcionar un protocolo de entrenamiento eficaz para la rehabilitación de personas con distensión del músculo psoas. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.
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Objective:To investigate the effects of extracorporeal shock-wave therapy wave (ESWT) and ultrasound therapy on pain relief and lumbar mobility in patients with lumbar myofascial pain.Methods:A total of 100 patients with lumbar myofascial pain who received treatment in The First People's Hospital of Jiande from March 2020 to March 2021 were included in this study. They were randomly divided into ESWT and ultrasound therapy groups, with 50 patients per group. The ESWT group was treated with ESWT at a frequency of 8 Hz and an energy density of 0.16 mJ/mm 2 once a week. The ultrasound therapy group was treated with ultrasound therapy at a frequency of 1.0 MHz and an intensity of 1.0 W/cm 2, once a day, 5 times a week, for 4 consecutive weeks. Therapeutic effects, pain relief and lumbar mobility improvement were observed in each group. Results:Total response rate in the ESWT group was significantly higher than that in the ultrasound therapy group [92.00% (46/50) vs. 76.00% (38/50), χ2 = 4.76, P < 0.05). After treatment, Visual Analogue Scale (VAS) score and Oswestry Dysfunction Index (ODI) score in the ESWT group were (2.56 ± 1.03) points and (20.22 ± 3.45) points, respectively, which were significantly lower than (3.83 ± 1.12) points and (25.13±3.72) points ( t = 5.90, 6.84, both P < 0.001). After treatment, anterior flexion, posterior extension, and lateral flexion of the lumbar spine in the ESWT group were (68.32 ± 8.67)°, (51.13 ± 6.56)°, (69.43 ± 8.27)°, respectively, which were significantly higher than (61.65 ± 8.51)°, (47.22 ± 6.50)°, (64.16 ± 7.69)° in the control group ( t = 3.88, 2.99, 3.30, all P < 0.05). Conclusion:Compared with ultrasonic therapy, ESWT for lumbar myofascial pain can better relieve pain, improve lumbar mobility, and enhance clinical efficacy.
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Objective:To evaluate the optimization efficacy of anterior quadratus lumborum block at supra-arcuate ligament (SA-AQLB) combined with general anesthesia for laparoscopic gynecological surgery.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 28-64 yr, weighing 52-78 kg, with height of 154-166 cm, scheduled for elective laparoscopic gynecological surgery, were divided into general anesthesia group (group G, n=40) and SA-AQLB combined with general anesthesia group (group SG, n=40) using a random number table method.In group SG, bilateral SA-AQLB was performed under ultrasound guidance before anesthesia induction, and 0.4% ropivacaine 25 ml plus dexamethasone 5 mg was injected into both sides.Combined intravenous-inhalational anesthesia was applied in both groups.Patient-controlled intravenous analgesia (PCIA) with sufentanil 2 μg/kg (in 150 ml of normal saline) was performed after surgery.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analogue scale (VAS) scores for abdomen, pelvis and shoulder pain were recorded at 1, 6, 12, 24 and 48 h after operation.Flurbiprofen was used for rescue analgesia when VAS score >4.The occurrence of intraoperative cardiovascular events and amount of sufentanil used during operation were recorded.The time to first pressing the analgesia pump, effective pressing times of PCA, requirement for rescue analgesia and consumption of sufentanil after operation were recorded.The extubation time, time to first flatus after operation, first ambulation time, length of hospital stay and development of postoperative adverse reactions such as nausea and vomiting, urinary retention and respiratory depression within 48 h after operation were recorded. Results:Compared with group G, the incidence of intraoperative hypertension and tachycardia was significantly decreased, the incidence of intraoperative hypotension and bradycardia was increased, the intraoperative consumption of sufentanil was reduced, the extubation time was shortened, the time to first pressing the analgesia pump was prolonged, the effective pressing times of PCA, requirement for rescue analgesia and postoperative consumption of sufentanil were reduced, the time to first flatus, first ambulation time and length of hospital stay were shortened, VAS scores for abdomen, pelvis and shoulder pain were decreased at each time point after operation, and the incidence of nausea and vomiting, urinary retention and respiratory depression after operation was decreased in group SG ( P<0.01). Conclusions:Compared with general anesthesia, the combination of SA-AQLB and general anesthesia can reduce the opioid consumption, inhibit intraoperative stress responses and postoperative hyperalgesia and promote early postoperative recovery when used for the patients undergoing laparoscopic gynecological surgery.
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ABSTRACT Objective: To compare the interobserver reliability of measurements of psoas morphology and lumbar lordosis in different positions and to standardize the performance of magnetic resonance imaging in the prone and lateral positions. Methods: This is a cross-sectional study carried out with asymptomatic volunteers of both sexes, aged over 18 years, with no known pathological changes in the lumbar region. Magnetic resonance imaging of the lumbar spine was performed in the supine, right lateral decubitus and prone positions, obtaining images in T2-weighted sequences in the sagittal and axial planes. The distances were measured from the psoas to the vertebral plateau and from the psoas to the lumbar plexus. The exams were assessed by two independent, blinded orthopedists. Results: There was excellent agreement between the measurements of vertebral size (ICC=0.92), low agreement for plexus distance (ICC=0.63) and high agreement for the anterior margin (ICC=0.84). Conclusion: There was good reproducibility of 2 of the 3 measures proposed, suggesting that the technique in the lateral and prone positions is capable of generating quality images. Level of Evidence 3B; Prospective.
RESUMO Objetivo: Comparar a confiabilidade interobservador da mensuração da morfologia do psoas e lordose lombar nas diferentes posições e padronizar a realização do exame de ressonância magnética em posição prona e lateral. Métodos: Trata-se de um estudo transversal realizado com voluntários assintomáticos de ambos os sexos, maiores de 18 anos, sem alterações patológicas conhecidas na região lombar. Foi realizada ressonância magnética da coluna lombar na posição supina, decúbito lateral direito e prono, obtendo imagens nas sequências ponderadas em T2 nos planos sagital e axial. Foram medidas as distâncias do psoas até o platô vertebral e o plexo lombar. Os exames foram avaliados por dois ortopedistas independentes em caráter cego. Resultados: Houve ótima concordância entre as medições do tamanho da vértebra (ICC=0.92), baixa concordância para a distância do plexo (ICC = 0,63) e alta concordância para a margem anterior (ICC = 0,84). Conclusão: Houve boa reprodutibilidade das medidas propostas, sugerindo que a técnica em posição lateral e prona é capaz de gerar imagens de qualidade. Nível de Evidência 3B; Prospectivo.
RESUMEN Objetivo: Comparar la fiabilidad interobservador de la medición de la morfología del psoas y la lordosis lumbar en diferentes posiciones y estandarizar la realización de la resonancia magnética en decúbito prono y lateral. Métodos: Se trata de un estudio transversal realizado con voluntarios asintomáticos de ambos sexos, mayores de 18 años, sin alteraciones patológicas conocidas en la región lumbar. Se realizó la resonancia magnética de la columna lumbar en decúbito supino, decúbito lateral derecho y prono, obteniendo imágenes en las secuencias potenciadas en T2 en los planos sagital y axial. Se midieron las distancias del psoas a la meseta vertebral y al plexo lumbar. Los exámenes fueron evaluados a ciegas por dos ortopedistas independientes. Resultados: Hubo una excelente concordancia entre las mediciones del tamaño de la vértebra (ICC = 0,92), una baja concordancia para la distancia del plexo (ICC = 0,63) y una alta concordancia para el margen anterior (ICC = 0,84). Conclusión: Hubo buena reproducibilidad de las medidas propuestas, lo que sugiere que la técnica en decúbito lateral y prono es capaz de generar imágenes de calidad. Nivel de evidencia 3B; Prospectivo.
Subject(s)
Humans , Male , Female , Adult , Magnetic Resonance Spectroscopy , Orthopedic Procedures , Diagnostic ImagingABSTRACT
Resumen La sarcopenia es la pérdida de masa y función muscular. Su presencia ensombrece el pronóstico de los pacientes cirróticos. El gold standard para la descripción de sarcopenia es el Skeletal Muscle Index (SMI). Se incluyeron 34 pacientes cirróticos. Se realizó medición a través de tomografía computarizada de ambos psoas por separado, que luego fueron sumados obteniendo lo que se denominó "suma de área de 2 psoas", además se midió área muscular total, SMI y área total de psoas. También se realizó ecografía y se midió el área transversal de recto anterior del cuádriceps por ecografía y Hand Grip (HG). Se analizó la corre lación entre las distintas mediciones comparando con el área muscular total, con área de cuádriceps (r = 0.39; P = 0.019), con área total de psoas (r = 0.71; P < 0.01), con suma de área de 2 psoas (r= 0.72; P < 0.001) y con HG (r = 0.45; P = 0.0069). Comparado con el SMI, en mujeres el HG tuvo 86% sensibilidad y 66% especificidad (AUC = 0.89). En hombres la suma de 2 psoas tuvo 91.7% de sensibilidad y especificidad (AUC = 0.82) y el área total de psoas tuvo 83.3% de sensibilidad y 76.9% de especificidad (AUC = 0.8). Hubo muy buena correlación entre los métodos de tomografía con el gold standard, y la correlación con la ecografía y la fuerza fue buena. Evaluando sensibilidad, especificidad y AUC, no se consideró un método útil para ambos sexos, comparado con el SMI
Abstract Sarcopenia is the loss of muscle mass and function. Its presence darkens the prognosis of cirrhotic patients. The gold standard for the description of sarcopenia is the Skeletal Muscle Index (SMI). Thirty-four cirrhotic patients were included. Measurement was carried out through CT of both psoas separately that were then added obtain ing the so called "sum of area of 2 psoas", in addition total muscular area, SMI and total area of psoas were measured. Ultrasonography was also performed and the transverse area of the quadriceps rectus anterior was measured by ultrasound and Hand Grip (HG). The correlation between the different measurements was analyzed comparing with the total muscle area, with quadriceps area (r = 0.39; p = 0.019), with total psoas area (r = 0.71; p <0.01), with sum of area of 2 psoas (r = 0.72; p <0.001) and with HG (r = 0.45; p = 0.0069). Compared with SMI, in women HG had 86% sensitivity and 66% specificity (AUC = 0.89). In men, the sum of 2 psoas had 91.7% sensitivity and specificity (AUC = 0.82) and the total area of psoas had 83.3% sensitivity and 76.9% specificity (AUC = 0.8). There was a very good correlation between the tomography methods with the gold standard. The correlation with ultrasound and strength was good. In the evaluation of sensitivity, specificity and AUC, it was not found a useful method when comparing with the SMI.
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Objective:To investigate the clinical efficacy of microacupotomy combined with Du pulse acupuncture in the treatment of lumbar and dorsal myofascial pain syndrome. Methods:110 patients with lumbar and dorsal myofascial pain syndrome who received treatment between February 2019 and August 2020 in Haining People's Hospital were included in this study. They were randomly assigned to receive either electroacupuncture (control group, n = 55) or microacupotomy combined with Du pulse acupuncture (observation group, n = 55). Therapeutic effects were compared between the control and observation groups. Results:Before treatment, there were no significant differences in tenderness and Visual Analogue Scale scores between the control and observation groups (both P > 0.05). After treatment, tenderness and VAS scores in the observation group were (0.81 ± 0.11) points and (2.36 ± 0.25) points, respectively, which were significantly lower than those in the control group [(1.31 ± 0.10) points, (3.34 ± 0.19) points, t = 24.943 and 23.146, both P < 0.001]. Effective rate in the observation group was significantly higher than that in the control group [98.18% (54/55) vs. 81.82% (45/55), χ2 = 8.182, P < 0.05]. After treatment, tenderness scores of the gluteus medius, psoas quadratus and multifidus muscles in each group were increased, and these scores in the observation group were significantly higher than those in the control group ( t = 3.937, 2.963 and 3.633, all P < 0.05). Conclusion:Microacupotomy combined with Du pulse acupuncture in the treatment of lumbar and dorsal myofascial pain syndrome can effectively decrease the degree of pain and strengthen clinical therapeutic effects.
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Introducción. Los sarcomas retroperitoneales son tumores raros, con una presentación clínica dada por síntomas compresivos poco específicos. Reporte de Caso: Reportamos un caso de un varón de 69 años con historia de lumbociatalgia e incremento en el volumen del miembro inferior izquierdo hasta llegar a la incapacidad para deambular, se le realizó una Tomografía Abdominal Con Contraste donde se halló una gran tumoración dependiente del músculo psoas iliaco izquierdo que se extendía hasta la pelvis, la cual fue sometida a biopsia encontrándose un Liposarcoma de psoas de alta celularidad. Conclusiones: Los sarcomas son tumores raros originados del tejido mesequenquimal, la gran mayoría de estos tienen síntomas y signos inespecíficos siendo diagnosticados de forma tardía y a pesar del manejo quirúrgico el pronóstico es pobre.
Introduction. Retroperitoneal sarcomas are rare tumors, with a clinical presentation given by poorly specific compression symptoms. Case Report: We report a case of a 69-year-old man with a history of lumbociatalgia and an increase in the volume of the left lower limb until he was unable to wander, he underwent a Contrast Abdominal Tomography where a large tumor dependent on the left iliac psoas muscle was found, that extended to the pelvis, which was biopsied, finding a highly cellular psoas Liposarcoma. Conclusions: Sarcomas are rare tumors originating from the mesequenchymal tissue, the vast majority of them have nonspecific symptoms and signs, being diagnosed late and despite the surgical management of the prognosis is poor.
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Resumen: Introducción: la hemofilia A es una coagulopatía congénita hereditaria ligada al cromosoma X que se expresa por una disminución del factor VIII de la coagulación. La expresión clínica es la hemorragia en diferentes localizaciones, siendo las más frecuentes las articulaciones, músculos y tejidos blandos. Objetivo: describir el caso clínico de un adolescente sin antecedentes patológicos que presentó un hematoma del psoas ilíaco sin causa aparente como forma de presentación atípica de una hemofilia A leve. Caso clínico: 13 años, varón, niega antecedentes patológicos. Deportista de alto impacto. Comenzó una semana previa al ingreso con coxalgia y dolor en miembro inferior izquierdo. Niega traumatismos. Intensidad progresiva del dolor, hasta impedir deambulación. Examen físico: dolor intenso y limitación a la movilización activa y pasiva de cadera izquierda. No bloqueo articular. Dolor a la palpación en fosa ilíaca izquierda. Resto del examen normal. Radiografía de pelvis: sin alteraciones. Resonancia magnética de pelvis: proceso expansivo sólido en músculo psoas ilíaco izquierdo de 110 mm por 50 mm por 60 mm. Dado el hallazgo, se reitera anamnesis y surge antecedente de hemofilia en abuelo materno y requerimientos de administración de factor VIII en tía materna frente a procedimientos invasivos. APTT prolongado que corrige con pool de plasma normal. Factor VIII: 12%. Se inició tratamiento sustitutivo con factor VIII con buena evolución. Conclusiones: el hematoma del psoas ilíaco es una hemorragia grave con elevada morbimortalidad de no realizar un diagnóstico y tratamiento oportunos. Su presentación clínica sin una causa aparente constituye una manifestación atípica de hemofilia leve. Es importante no subestimar el riesgo de sangrado en estos pacientes, ya que presenta una mayor morbimortalidad en el mismo escenario clínico en comparación con formas más severas de enfermedad.
Summary: Introduction: type A hemophilia is an inherited congenital coagulopathy linked to chromosome X, expressed by a decrease in coagulation factor VIII. Its clinical expression is hemorrhage in different locations, mainly joints, muscles and soft tissue. Objective: to describe the clinical case of an adolescent with no previous history of pathology, who consulted for a psoas iliacus haematoma with no apparent cause, as an atypical presentation of mild type A hemophilia. Clinical case: 13 years of age, male, denies previous history of pathology. Practices high impact sports. Consults for coxalgia and pain in left lower limb. Denies trauma. Pain progressively intense, until it prevented patient from walking. Physical examination: intense pain and limitation of active and passive movement of the left hip. Pain at palpation of left iliac fossa. The remaining examination is normal. Pelvic X ray shows no alterations. Pelvic magnetic resonance: solid expansive process in the left psoas iliacus of 110 mm x 50 mm x 60 mm. After this finding, we repeated the anamnesis and discovered a history of hemophilia in the maternal grandfather and the administration of factor VIII to a maternal aunt when subject to invasive procedures. Prolonged APTT was corrected with normal plasma pool. Factor VIII: 12%. We started substitution treatment with factor VIII, with a favorable evolution. Conclusions: haematoma of the psoas iliacus is a severe hemorrhage with high levels of morbi-mortality if no timely diagnosis or treatment is performed. Its clinical presentation with no apparent cause is an atypical manifestation of mild hemophilia. It is important not to underestimate the risk of bleeding in these patients, since they show greater morbimortality in the same clinical scenario compared with more severe presentations of the disease.
Resumo: Introdução: a hemofilia A é uma coagulopatia congênita hereditária ligada ao cromossoma X que se expressa por uma diminuição do fator VIII de coagulação. A expressão clínica é hemorragia em diferentes localizações, sendo as mais frequentes as articulações, músculos e tecidos moles. Objetivo: descrever o caso clínico de um adolescente sem patologias previas que apresentou hematoma do psoas ilíaco sem causa aparente como forma atípica de hemofilia A leve. Caso clínico: 13 anos, sexo masculino, nega história patológica. Atleta de alto impacto. Uma semana antes da admissão começou com coxalgia e dor no membro inferior esquerdo. Nega haver tido traumatismos. Intensidade progressiva da dor, até que não pode caminhar. Exame físico: dor intensa e limitação da mobilização ativa e passiva do quadril esquerdo. Sem bloqueio articolar. Dor à palpação na fossa ilíaca esquerda. Resto do exame normal. Radiografia de pelve sem alterações. Ressonância magnética pélvica: processo expansivo sólido no músculo psoas ilíaco esquerdo medindo 110 mm x 50 mm x 60 mm. Devido a esse achado, repetimos a anamnese e surge história de hemofilia no avô materno e administração do fator VIII na tia materna devido a procedimentos invasivos. APTT prolongado que corrige com pool de plasma normal. Fator VIII: 12%. Iniciamos o tratamento de substituição com fator VIII com boa evolução. Conclusões: o hematoma de iliopsoas é uma hemorragia grave com alta morbimortalidade no caso de não existir diagnóstico e tratamento oportunos. Sua apresentação clínica sem causa aparente constitui uma manifestação atípica de hemofilia leve. É importante não subestimar o risco de sangramento nesses pacientes, visto que eles apresentam maior morbimortalidade no mesmo ambiente clínico em comparação às formas mais graves da doença.
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Objective To evaluate the effect of ultrasound-guided continuous anterior quadratus lumborum block (QLB) on postoperative analgesia in total hip arthroplasty.Methods Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes,aged 65-80 yr,weighing 45-80 kg,scheduled for elective total hip arthroplasty under subarachnoid block,were divided into 2 groups (n =25 each) using a random number table method:ultrasound-guided continuous anterior quadratus lumborum block group (group Q) and routine analgesia group (group R).Anterior QLB was performed at the end of operation in group Q.Patient-controlled intravenous analgesia was performed with sufentanil after operation in two groups.Dezocine was given as rescue analgesic.Ramsay sedation score and the maximum angle for hip flexion and abduction of hip joint were recorded after operation,and the total consumption of sufentanil,requirement for dezocine and occurrence of adverse reactions were recorded within 72 h after operation.The occurrence of QLB-related complications was also recorded.Results Compared with group R,Ramsay sedation score was significantly decreased and the maximum angle for hip flexion and abduction of hip joint were increased at each time point after operation,and the total consumption of sufentanil,requirement for dezocine and incidence of nausea and vomiting were decreased in group Q (P ＜ 0.05).No QLB-related complications were found in group Q.Conclusion Ultrasound-guided continuous anterior QLB can produce better postoperative analgesia and reduce postoperative consumption of opioids with fewer adverse reactions in the patients undergoing total hip arthroplasty.
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Objective To observe the analgesic effect of quadratus lumborum block (QLB) in cesarean section under general anesthesia.Methods 50 patients underwent cesarean section under general anesthesia were randomly divided into two groups (n =25):patients in QLB group (group Q) received QLB at the end of surgery with 0.3％ ropivacaine 25ml,and the control group (group C) patients were disinfected at the same site but did not puncture.The visual analogue scale (VAS) and pain Bruggrmann comfort score (BCS) were recorded at 2,6,12,24,and 48 hours after surgery.The patient's general condition,vital signs and postoperative analgesia-related adverse reactions were recorded.Results There were no significant differences between the two groups in general information and surgical related indexes (P ＞ 0.05).The VAS scores of the Q group were lower than the control group at 2,6,12 and 24 hours,and the BCS score was higher than that in the control group (P ＜ 0.05).There was no difference in VAS score,BCS score after 48 hours,and no difference in adverse reaction rate between the two groups (P ＞ 0.05).Conclusions Quadratus lumborum block combined with intravenous analgesia can reduce the pain score within 24 hours after cesarean section under general anesthesia and improve postoperative analgesia comfort.
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Intramuscular hematomas on the psoas muscle are rare and usually occur as a result of trauma, iatrogenic etiology during lumbar surgery, rupture of the aortic aneurysm, and hematologic diseases. The incidence of spontaneous psoas muscle hematomas has slowly increased as a result of using anticoagulation and antiplatelet agents. Magnetic resonance (MR) imaging is a more sensitive option compared to computed tomography (CT) when diagnosing a hematoma. Coronal T2-weighted images are more useful. CT imaging is also useful to establish the rapid diagnosis of hematoma. When a prolonged prothrombin time and international normalized ratio and decrease platelet count are noted, psoas muscle hematomas should be considered, if there was no lesion in the spinal canal. Most hematomas resolve spontaneously without clinical complications if the hematoma is not large or it is not compressing the surrounding important structures, irrespective of cause.
Subject(s)
Aortic Aneurysm , Diagnosis , Hematologic Diseases , Hematoma , Incidence , International Normalized Ratio , Magnetic Resonance Imaging , Platelet Aggregation Inhibitors , Platelet Count , Prothrombin Time , Psoas Muscles , Rupture , Spinal CanalABSTRACT
Subject(s)
Cadaver , Embryology , Femoral Nerve , Femur , Intervertebral Disc , Ligaments , Lumbosacral Plexus , Pelvis , Psoas Muscles , Spinal Nerves , Spine , SurgeonsABSTRACT
Objective To evaluate the modifying efficacy of quadratus lumborum block ( QLB ) combined with general anesthesia in the patients undergoing percutaneous nephrolithotomy ( PCNL) . Meth-ods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 33-64 yr, with body mass index of 18-27 kg∕m2 , scheduled for elective PCNL with general anesthesia, were divided into general anesthesia group ( group GA) and QLB combined with general anesthesia group ( group QLB+GA) , with 30 patients in each group. In group QLB+GA, the anterior approach to QLB was performed with 0. 357％ ropivacaine 20 ml on the side of operation under the ultrasound guidance before induction of anes-thesia. Anesthesia was induced with IV midazolam, propofol, sufentanil and cisatracurium. Anesthesia was maintained by intravenously infusing propofol, remifentanil and cisatracurium. Patient-controlled intra-venous analgesia ( PCIA) was performed at the end of operation. PCIA solution contained sufentanil 2μg∕kg in 100 ml of normal saline. The PCA pump was set up with a 2 ml bolus dose, a 15-min lockout in-terval, and background infusion at a rate of 2 ml∕h. Numeric rating scale score was maintained ≤ 3 after operation. When numeric rating scale score ≥4, flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic. The intraoperative consumption of propofol and remifentanil, occurrence of adverse reac-tions ( nausea and vomiting, agitation, respiratory depression, somnolence) in postanesthesia care unit, consumption of sufentanil for PCIA within 48 h after operation, the number of successfully delivered doses, requirement for rescue analgesics, recovery time of intestinal exhaust gas, and length of postoperative hos-pital stay were recorded. Results Compared with group GA, the intraoperative consumption of propofol and remifentanil was significantly reduced, the rate of rescue analgesia, consumption of sufentanil for PCIA within 48 h after operation and the number of successfully delivered doses were decreased, the incidence of agitation, respiratory depression and somnolence in postanesthesia care unit was decreased, and the recov-ery time of intestinal exhaust gas and length of postoperative hospital stay were shortened in group QLB+GA ( P<0. 05) . Conclusion QLB combined with general anesthesia is helpful in carrying out the anesthetic model of low-consumption opioids and more helpful in inhibiting postoperative pain responses and promoting postoperative recovery than general anesthesia alone in patients undergoing PCNL.
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Objective To evaluate the efficacy of ultrasound-guided anterior quadratus lumborum block combined with general anesthesia for laparoscopic radical resection of rectal carcinoma. Methods A total of 80 patients of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, aged 40-64 yr, scheduled for elective laparoscopic radical resection of rectal carcinoma, were divided into 2 groups ( n=40 each) using a random number table method: anterior quadratus lumborum block combined with general anesthesia group ( group QG) and general anesthesia group ( group G) . In group QG, anteri-or quadratus lumborum block was performed with 0. 33％ ropivacaine 25 ml and dexamethasone 5 mg under ultrasound guidance before operation, and the same procedure was performed on the other side. Combined intravenous-inhalational anesthesia was applied, propofol 3-5μg∕ml and remifentanil 3-5 ng∕ml were given by target-controlled infusion, and cisatracurium was intermittently injected in two groups. Patient-controlled intravenous analgesia with sufentanil 2μg∕kg was used for postoperative analgesia. The analgesic pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval. Bruggrmann comfort scale ( BCS) scores were recorded at 1, 6, 12, 24 and 48 h after operation ( T1-5 ) . Tramadol was used for rescue analgesic after operation. The consumption of remifentanil and sufentanil, requirement for tramadol, occurrence of adverse reactions and patients' satisfaction with postoperative analgesia were recorded. The emergence time, first ambulation time, time to first flatus∕poo and length of hospital stay were also recorded. The develop-ment of anterior quadratus lumborum block-related complications was recorded. Results Compared with group G, BCS scores were significantly increased at T4,5 , the consumption of remifentanil, requirement for tramadol and incidence of nausea and vomiting were decreased, patients' satisfaction with postoperative an-algesia was increased, and the emergence time, first ambulation time, time to first flatus∕poo and length of hospital stay were shortened in group QG (P<0. 05). Conclusion Ultrasound-guided anterior quadratus lumborum block combined with general anesthesia can reduce the consumption of opioids in the perioperative period and is helpful in improving outcomes when used for laparoscopic radical resection of rectal carcinoma.
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Objective To evaluate the efficacy of quadrates lumborum block for unilateral inguinal hernia repair in elderly patients. Methods Fifty-eight elderly patients with unilateral inguinal hernia of both sexes, aged 65-80 yr, with body mass index of 18-25 kg∕m2 , of American Society of Anesthesiolo-gists physical status Ⅱ or Ⅲ, scheduled for elective unilateral tension-free repair, were divided into 2 groups ( n=29 each) using a random number table method: iliohypogastric-ilioinguinal nerve block group (group T) and quadrates lumborum block group (group Q). Iliohypogastric-ilioinguinal nerve block with arteria circumflexa ilium profunda as a marker was carried out with 0. 33％ ropivacaine 20 ml under ultra-sound guidance in group T. The anterior approach to quadratus lumborum block was performed with 0. 33％ropivacaine 20 ml under ultrasound guidance in group Q. Operation was started after the height of sensory block was assessed by pin-prick test at 30 min after block. When the blocking effect did not meet the opera-tion requirements, an increment of 1％ lidocaine 2. 5 ml was given every time in the surgical field until op-eration requirements were met. Dexmedetomidine was intravenously infused at a rate of 0. 03-0. 07μg·kg-1 ·min-1 during surgery until the end of surgery to maintain Narcotrend index between 80 and 90. When postoperative visual analogue scale score >3, parecoxib sodium 40 mg was intravenously injected, and if marked pain relief was not found 10 min later, tramadol hydrochloride 50-100 mg was intravenously injected. The upper spread of sensory block and intraoperative requirement for additional local anesthetics were recorded at 30 min after nerve block. The requirement for parecoxib and tramadol was recorded within 48 h after operation. The development of inadvertent intravascular injection of local anesthetics, local anes-thetic intoxication and postoperative nausea and vomiting, nerve block of lower extremity and uroschesis was recorded. Results Skin pain disappeared at the plane of T11-L1 in group T and at the plane of T9-L1 in group Q. Compared with group T, the intraoperative requirement for and consumption of local anesthetics, postoperative requirement for parecoxib and tramadol, and postoperative incidence of nausea and vomiting were significantly decreased in group Q ( P<0. 05) . Conclusion Quadrates lumborum block provides bet-ter efficacy for unilateral inguinal hernia repair than iliohypogastric-ilioinguinal nerve block in elderly pa-tients.
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ABSTRACT Objective: Spine surgery with a minimally invasive lateral approach and validate possible anatomical differences between the right and left sides. Methods: Four measurements (cm) were taken on 38 cadavers: the distance between the lumbar plexus and the transverse process (L4-L5) and the distance between the lumbar plexus and the midline of the lumbar spine, both on the right and left sides. Results: The mean distance between the lumbar plexus and the transverse process of L4-L5 was 1.03 cm and the distance to the midline was 3.99 cm for the right side. The averages of the left side were 1.13 cm and 3.38 cm, respectively. There is statistical difference between the sides (p<0.05) using the non-parametric Wilcoxon test. Conclusions: The authors suggest that the transverse process might be used as an anatomical landmark to define the surgical approach through the psoas muscle. Level of Evidence IV; Cadaveric study.
RESUMO Objetivo: Encontrar um referencial anatômico prático e seguro durante a cirurgia com a técnica de acesso à coluna ALMI (acesso lateral minimamente invasivo) e validar possíveis diferenças anatômicas entre os lados direito e esquerdo. Método: Foram feitas 4 medidas (cm) em 38 cadáveres: entre o plexo lombar e o processo transverso de L4L5, e entre o plexo lombar e a linha média da coluna lombar dos lados direito e esquerdo. Resultados: A distância média encontrada entre o plexo lombar e o processo transverso de L4L5 foi de 1,03cm e a distância até a linha média foi de 3,99 cm do lado direito. Já do lado esquerdo, as médias são 1,13cm e 3,88cm, respectivamente. Houve diferença estatística entre os lados (p<0,05) pelo teste não-paramétrico de Wilcoxon. Conclusão: Sugere-se como referencial anatômico o processo transverso para definir o ponto de entrada do portal de trabalho no músculo psoas. Nível de Evidência IV; Estudo Cadavérico.
RESUMEN Objetivo: Encontrar una referencia anatómica práctica y segura durante la cirugía de la columna con técnica de abordaje lateral mínimamente invasivo y validar posibles diferencias anatómicas entre los lados derecho e izquierdo. Métodos: Se realizaron 4 medidas (cm) en 38 cadáveres: distancia entre el plexo lumbar y la apófisis transversa (L4-L5) y distancia entre el plexo lumbar y la línea media de la columna lumbar, en los lados derecho e izquierdo. Resultados: La distancia promedio entre el plexo lumbar y la apófisis transversa de L4-L5 fue 1,03 cm y la distancia a la línea media fue de 3,99 cm a la derecha. Los promedios de la izquierda fueron 1,13 cm y 3,88 cm respectivamente. Hay diferencia estadística entre los lados (p <0,05) mediante la prueba no paramétrica de Wilcoxon. Conclusiones: Se sugiere como referencia anatómica la apófisis transversa para definir el portal de trabajo a través del músculo psoas. Nivel de Evidencia IV; Estudio cadavérico.