小切口减张术治疗下肢骨筋膜室综合征临床研究

目的观察小切口减张术治疗下肢骨筋膜室综合征的疗效。方法回顾性分析南京大学医学院附属鼓楼医院1992年2月至2005年7月收治的37例下肢动脉栓塞术后再灌注损伤致小腿骨筋膜室综合征病人资料。均采用小切口减张术(即在小腿内、外侧各取纵行切口,长2~3cm,游离皮下组织直至深筋膜,打开深筋膜,将剪刀伸进切口内,分别向近、远端潜行剪开深筋膜,上至膝关节下,下至内踝)治疗。同时结合高渗脱水、利尿、伤口延期缝合等,观察其疗效。结果37例病人中33例痊愈,2例发生足趾坏疽行截趾术,2例出现小腿感觉障碍,给予营养神经药物治疗3个月后恢复,无一例发生缺血性肌痉挛及高位截肢。其中22例微小减张切口行Ⅱ期缝合,15例自行愈合,无一例植皮。结论小切口减张术用于骨筋膜室综合征具有损伤轻微、创面小、细胞外液和蛋白损失少、感染概率相对较低,部分小切口能够自行愈合、无须Ⅱ期缝合或植皮等优点,方法实用,值得推广。

Investigation of Micro-incision in the treatment of osteofascial compartment syndrome

Objective To investigate the therapeutic effect of micro-incision in the treatment of osteofascial compartment syndrome.Methods The clinical data of 37 patients with osteofascial compartment syndrome caused by reperfusion injury after embolectomy admitted between February 1992 and July 2005 were analyzed retrospectively.All patients were performed open decompression operation on the legs with micro-incision.At the same time,the patients were given dehydration,diuresis drugs.The wounds were deferred the suturation time.Results Among the 37 patients,33 patients were fully recovered.Two patients had toes mortification and got toe amputation operation.Two patients had sensory disability on legs and got recovered after trophic nerve medicine treatment three months later.No patient got ischemia muscle spasm or high amputation.The micro-incision got secondary suture in 22 patients and self-cure in 15.Conclusion The therapeutic effect of micro-incision in the treatment of osteofascial compartment syndrome caused by reperfusion injury is satisfactory.Its forte is slight injury,small wound surface,little loss of extracellular fluid and protein,low probability of infection;self-cure in part of the micro-incision,no need of dermatoplasty.