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患者,男,20岁.因房屋倒塌砸伤半小时入院.诊断:创伤失血性休克、颅脑损伤、肝脾破裂,左股骨骨折、骨盆骨折,L_3横突骨折.入院后紧急输血输液纠正休克,行剖腹术,见肝脾破裂、腹膜后血肿,行肝缝合修补、脾切除、腹腔引流术,术后抗生素及支持疗法,伤口Ⅰ期愈合,一般情况改善后,又在硬膜外麻醉下行左股骨切开复位,髓内针固定,距受伤21天,发现右下肢肌肉萎缩,肌力减弱,同时病人述说右臀部及右下肢轻微疼痛,放射至足底.腰椎CT发现L_5、S_1轻度滑脱,L_(1-5)、L_5S_1椎间盘突出,右侧神经根受压.3天后,(距受伤24天)病人感右臀部剧烈胀痛,出现肿块,逐渐增大,右下肢伸直时痛加剧.检查:右臀部肿胀、呈弥漫性隆起.压痛明显.有波动,皮温不高.B超示右臀部血肿11cm×4cm.穿刺抽出陈旧性及新鲜血液.在臀部波动最明显处纵形切开长5cm伤口,于筋膜下有约200ml陈旧性血液流出,疼痛有所缓解.随即钝性分离臀大肌,见有2块约5cm×3cm×2cm陈旧性血块涌
The patient, male, 20 years old, was injured in half an hour after the house collapsed and was admitted to hospital Diagnosis: traumatic hemorrhagic shock, head injury, liver and spleen rupture, left femoral fracture, pelvic fracture, L_3 transverse process fracture Emergency blood transfusions corrected shock , Laparotomy, liver and spleen rupture, retroperitoneal hematoma, liver suture repair, splenectomy, abdominal drainage, postoperative antibiotics and supportive therapy, wound healing in the first, the general situation improved, and in the epidural anesthesia down Left femur incision and reduction, fixed intramedullary nail, 21 days after injury, found that the right lower extremity muscle atrophy, muscle weakness, while the patient described the right hip and right lower extremity minor pain, radiation to the plantar.Lumbar CT found L_5, S_1 mild After 3 days, the pain of the right buttocks was severe and painful in patients with l_ (1-5), L_5S_1 disc herniation and right nerve root compression. Exacerbated. Check: swelling of the right buttocks, was diffuse bulge. Tenderness was obvious. Fluctuation, skin temperature is not high. B ultrasound showed right hip hematoma 11cm × 4cm. Puncture out of old and fresh blood. Open 5cm wound, under the fascia about 200ml old blood flow Pain eased. Then blunt dissection of the gluteus maximus, two saw about 5cm × 3cm × 2cm Chung old blood clots