- 期刊
Morel-Lavallee Lesion - Our Experience and Review
Morel-Lavallee病灶－我們的經驗與回顧
摘要
Background: Morel-Lavallee lesion is a post-traumatic closed degloving injury between the subcutaneous tissue and deep fascia characterized by a growing mass localized in specific area. The lesion is usually caused by high-energy trauma associated with bone fracture and hemodynamic instability in acute stage. However, low energy trauma related lesions were also reported. The diagnosis and management of these lesions are not fully established. The images of the lesions vary with time. In delayed developed chronic lesion, the lesion could be misdiagnosed as sarcoma because of capsule formation and peripheral vascularity. Treatment failure was not rare in Morel-Lavallee lesion. Aim and Objectives: Reviewed our cases of Morel-Lavallee lesion, shared our experience in management, and reviewed articles to improve our clinical practice. Materials and Methods: From 2006 to 2016, we collected information from individuals who were diagnosed with Morel-Lavallee lesion. Patient characteristics including age, sex, duration from trauma to diagnosis, trauma mechanism, location of lesion, combined fracture or not, vital signs, hemoglobin level, management, and infection or not were investigated. Moreover, whether there is recurrence after conservative treatment or open debridement was assessed. SPSS statistics version 22.0 was used for further analysis. Related articles were also reviewed for the latest information and management. Results: A total of 15 patients in our hospital were diagnosed with Morel-Lavallee lesion. High-energy trauma was found in 14 cases, the cause of the remained 1 patient was unknwon. There were 4 patients had unstable vital signs in acute stage, and 7 patients associated bone fracture. The treatment failure rate of conservative management was high and significantly higher than that of open debridement (60% versus 11%, p-value = 0.045). One experienced recurrence even after undergoing conservative management and open debridement. Conclusions: The diagnosis and management of Morel-Lavallee lesion is still a challenge. Conservative treatment could be tried in acute lesions, but it was usually useless in chronic lesions. Surgical debridement was the most reliable way of management.
並列摘要
背景：Morel-Lavallee病灶是一個創傷後造成的皮下組織與深筋膜層的脫套傷，臨床上常以一些特定部位產生逐漸增大的腫塊來表現。此病灶通常源自於一些高能量的創傷，在急性期時常伴隨著不穩定的生命徵象及骨折。然而在一些低能量的創傷患者身上也可以發現這種病灶。這些病灶的診斷和處置方法還沒有完全被建立。影像上的表現會隨著時間而改變，一些延遲產生的慢性的病灶有可能會因為披膜的產生及周圍的血管生成而被誤以為是肉瘤。而治療失敗在Morel-Lavallee病灶裡並不罕見。目的及目標：回顧及分享我們診斷為Morel-Lavallee病灶患者的特性及經驗，並回顧相關的文章藉此來改善我們的臨床處置。材料及方法：我們收集了從2006年至2016年在我們醫院診斷為Morel-Lavallee病灶的病人，病患的年紀、性別、創傷至診斷的時間、創傷機轉、病灶位置、是否合併骨折、生命徵象、血紅素值、處置，及是否有感染被回顧。另外在接受保守治療或開放性清創後是否有復發也被評估。SPSS統計軟體被用來完成相關的統計。一些相關的文章被回顧以獲取最新的資訊及處置方法。結果：總共有15個病人被診斷為Morel-Lavallee病灶，其中有14個病人是高能量創傷所導致，而剩下那一位則原因不明。有4個病人在急性期時生命徵象不穩定，有7個病人合併有骨折。保守治療的失敗率顯著高於開放性清創治療（百分之60比上百分之11，p值0.045），有一位病人即使接受了保守治療及清創手術後仍然復發。結論：Morel-Lavallee lesion的診斷及治療仍然是一個挑戰，保守治療在急性期的病灶可以嘗試，但用在慢性病灶往往是失敗的。手術清創是最可靠的處理方式。