小腿骨筋膜室综合征治疗体会

目的:本文介绍43例小腿骨筋膜室综合征的治疗经验和一种新的暂时闭合筋膜切开减压伤口的方法.方法:采用回顾性研究.结果:外伤后直接接受治疗的35例病人中,33例获得优良结果,无后遗症,1例因严重挫伤而截肢,1例手术后死于急性肾功能衰竭和DIC.由外院治疗后转入的8例病人中,5例出现Volkmann缺血性肌挛缩,3例因肢体坏死而截肢.5例筋膜切开减压术后的伤口采用人工皮覆盖,二次手术伤口直接缝合.结论:小腿骨筋膜室综合征早期采用保守治疗对部分病人是有效的,如在治疗过程中症状、体征恶化,应尽早行筋膜室切开减压术.采用人工皮及负压吸引系统覆盖伤口能迅速降低组织压,防止感染.     

小腿骨筋膜室综合征治疗体会

目的:本文介绍43例小腿骨筋膜室综合征的治疗经验和一种新的暂时闭合筋膜切开减压伤口的方法。方法:采用回顾性研究。结果:外伤后直接接受治疗的35例病人中,33例获得优良结果,无后遗症,1例因严重挫伤而截肢,1例手术后死于急性肾功能衰竭和DIC。由外院治疗后转入的8例病人中,5例出现Volkmann缺血性肌挛缩,3例因肢体坏死而截肢。5例筋膜切开减压术后的伤口采用人工皮覆盖,二次手术伤口直接缝合。结论:小腿骨筋膜室综合征早期采用保守治疗对部分病人是有效的,如在治疗过程中症状、体征恶化,应尽早行筋膜室切开减压术。采用人工皮及负压吸引系统覆盖伤口能迅速降低组织压,防止感染。     

煤气中毒致小腿骨筋膜室综合征3例救治体会

小腿骨筋膜室综合征常见于重物挤压、石膏固定包扎过紧、肢体血管伤等原因 ,而煤气中毒致小腿骨筋膜室综合征临床少见 ,我们救治 3例 ,现报告如下。病例 1,李×× ,男性 ,2 7岁 ,煤气中毒后 16小时入院。查体 :血压 12 0 / 90 m m Hg(16 / 12 k Pa) ,神志清楚 ,右小腿肿胀明显 ,小腿外侧、右足背、足底感觉减退 ,小腿及足部诸肌肌力均为 级 ,被动牵拉试验阳性 ,尿常规蛋白 ( ) ,潜血( ) ,尿素氮 7.8mm ol/ L,肌电图示腓总神经及胫神经有轻度损害 ,入院后急行“右小腿骨筋膜室综合征切开减压术”,术后应用 2 0 %甘露醇脱水 ,低分子右旋糖…     

腘血管损伤致小腿骨筋膜室综合征的治疗体会

<正>临床上常见的小腿骨筋膜室综合征是由于小腿闭合性骨折、软组织伤引起的筋膜间室张力增高,从而引起肌肉和神经急性缺血、缺氧产生的一系列症状和体征。但是我们注意到单纯的腘血管损伤也可引起急性骨筋膜室综合征,因为发病机制的不同,其临床特征、治疗和预后等与前者均有所不同。我们从2005年1月至2013年10月共治疗腘血管损伤引发小腿骨筋膜室综合征12例,总结分析其发病特点及治疗效果,现报告如下。     

小腿骨筋膜室综合征的定位诊断与治疗

目的研究探讨小腿骨筋膜室综合征的定位诊断及治疗效果。方法2000年1月至2005年1月,对240例患者采用改良W h ites ide法测压装置监测小腿骨筋膜室内压。80例患者骨筋膜室内压大于等于30 mmHg(1 mmHg=0.133 kPa),其中前侧骨筋膜室8例,外侧骨筋膜室12例,后浅骨筋膜室16例,后深骨筋膜室28例,涉及2个以上骨筋膜室16例。确认后切开各压力升高的骨筋膜室,前侧和外侧骨筋膜室取小腿前外侧切口,后浅和后深骨筋膜室取胫骨内缘后侧切口,合并胫腓骨骨折者,在切开减压的同时固定骨折,数天后切口二期处理。结果80例患者均获随访5~35个月,平均2年,8例较长时间行走后出现小腿局限性疼痛,偶有放射痛,占10%;4例两点辨别觉及针刺觉减退,占5%;无一例出现肌肉萎缩、爪形趾、缺血性肌挛缩及运动障碍,均能进行正常的工作与生活。结论小腿损伤后,骨筋膜室综合征的发生不容忽视,各骨筋膜室内组织压监测是定位诊断的惟一可靠方法,根据定位诊断有针对性的减压各骨筋膜室,减少了不必要的损伤,可最大限度地恢复小腿的功能。     

中西医结合疗法治疗小腿骨筋膜室综合征

目的　报告中西医结合治疗小腿骨筋膜室综合征的效果。方法　 73例小腿骨筋膜室综合征患者 ,采用中西医结合疗法 ,即 :早期切开减张 ,跟骨牵引或开放复位 ,高渗脱水 ,伤口延期缝合 ,中药换药或植皮术。结果　 6 9例经随访创面全部愈合。延期缝合结合应用中药生肌橡皮膏 ,对预防和控制减张创口的感染 ,促进创面愈合 ,是一种有效的方法。本组创面感染率为 15.2 %。结论　该综合征以中西医结合的疗法治疗 ,取得满意的效疗     

小腿骨筋膜室综合征40例治疗分析

我院自2000年5月-2003年10月共治疗小腿骨筋膜室综合征40例，疗效满意，报告如下。     

儿童骨筋膜室综合征的治疗体会

目的研究儿童骨筋膜室综合征临床特点。方法对10例儿童骨筋膜室综合征患者的临床病例资料进行回顾性分析,描述儿童骨筋膜室征早期临床特征,总结治疗方法及预后。结果10例均获随访,随访时间为6～18个月。按HSS（美国特种外科医院）关节功能恢复评分标准,本组优5例、良4例、差1例。结论儿童骨筋膜室综合征的早期临床表现不典型,诊断困难,病情进展迅速、后果严重。     

小腿骨筋膜间室综合征5例报告

筋膜间室综合征是创伤后肢体因肿胀而引起密闭的筋膜间室内的血液循环障碍,最终导致肢体的感觉障碍,如不及时处理可引起肢体伤残的严重后果,本文总结2001年1月~2006年8月以来骨科手术后发生骨筋膜间室综合征5例,对其原因进行了探讨分析,并提出预防措施及治疗的经验教训。1临床资料和方法1.1一般资料本组共5例,男4例,女1例,年龄23~37岁,平均24.5岁。2例为胫腓骨骨折开放复位钢板内固定术后发生,1例为左小腿刀砍伤清创缝合术后发生,1例为小腿前侧肌疝行肌疝手术修补后发生,1例为儿麻后遗症左胫骨上端手术截骨半环槽支架延长术后发生。1.2典型…     

Compartment Syndrome of the Lower Leg and Foot

Compartment syndrome of the lower leg or foot, a severe complication with a low incidence, is mostly caused by high-energy deceleration trauma. The diagnosis is based on clinical examination and intracompartmental pressure measurement. The most sensitive clinical symptom of compartment syndrome is severe pain. Clinical findings must be documented carefully. A fasciotomy should be performed when the difference between compartment pressure and diastolic blood pressure is less than 30 mm Hg or when clinical symptoms are obvious. Once the diagnosis is made, immediate fasciotomy of all compartments is required. Fasciotomy of the lower leg can be performed either by one lateral incision or by medial and lateral incisions. The compartment syndrome of the foot requires thorough examination of all compartments with special focus on the calcaneal compartment. Depending on the injury, clinical examination, and compartment pressure, fasciotomy is recommended via a dorsal and/or medial plantar approach. Surgical management does not eliminate the risk of developing nerve and muscle dysfunction. When left untreated, poor outcomes with contractures, toe deformities, paralysis, and sensory neuropathy can be expected. In severe cases, amputation may be necessary.     

Acute Compartment Syndrome after Lower Leg Fracture

European Journal of Trauma and Emergency Surgery - In acute situations, fasciotomy can be done prophylactically or as early therapeutic decompression, the latter being performed as soon as the...     

Acute Compartment Syndrome after Lower Leg Fracture

AbstractBackground: In acute situations, fasciotomy can be done prophylactically or as early therapeutic decompression, the latter being performed as soon as the first symptoms of compartment syndrome are present.Patients and Methods: Results of fasciotomy after lower leg fracture performed between 1992 and 2001 were reviewed with emphasis on the efficacy of treatment and morbidity of the procedure sec. Patients, divided into a prophylactic group (A) and a therapeutic fasciotomy group (B), were interviewed and examined, focusing on late sequelae of compartment syndrome and of the fasciotomy sec. Results: 52 patients were followed up after a median period of 40 months, 18 in group A and 34 in group B. All fractures in group A were operated within 24 h, one third of patients in group B underwent surgery later. In group A, one short foot syndrome was found. In group B, five amputations were performed for ischemic muscle necrosis, two short foot syndromes were observed, and five legs showed other late compelling signs of manifest compartment syndrome. In the 31 legs without sustained compartment syndrome, only seven had no fasciotomy-related abnormalities besides a scar; reduced endurance and swelling were most frequently found. An iatrogenic superficial peroneal nerve lesion was diagnosed in seven legs. Conclusion: Outcome after prophylactic fasciotomy seems to be superior to that after early therapeutic decompression. Though prophylactic fasciotomy is effective, its morbidity is quite high, with long-term consequences in three quarters of patients.     

Reconstructive Surgery after Compartment Syndrome of the Lower Leg and Foot

Abstract  Compartment syndrome at the lower extremity, if overlooked or treated inadequately in polytraumatized and multiply injured patients, regularly leads to progressive foot deformities and severe loss of function in the affected patients. The sequelae of compartment syndrome directly result from muscle contracture, necrosis and scarring and are further affected over time by gravity and posture (especially the sleeping position with the foot in equinus and inversion). While overlooked compartment syndrome of the lower leg leads to deformities of the whole foot, most frequently equinovarus, compartment syndrome of the foot results in painful toe deformities, mostly hammer or claw toes. Treatment aims at functional rehabilitation of the foot and ankle. Flexible deformities are treated with tendon lengthening or tendon transfer based on a thorough clinical evaluation of the remaining muscle force. Progressive contractures are subject to tenotomy, extensive capsular release and excision of scarred tissue. Corrective fusions should be reserved for long-standing deformities with symptomatic arthritis. They are combined with soft-tissue procedures as indicated. Please see related articles in Eur J Trauma Emerg Surg 33;6:576–612.     

Compartment Syndrome of the Lower Extremity

Abstract Acute compartment syndrome of the lower extremity is a limb-threatening emergency that requires prompt surgical treatment. Early detection and decompression are necessary in order to avoid irreversible damage. In the lower extremity, compartment syndrome may occur around the pelvis, in the thigh, the lower leg or the foot. Acute compartment syndrome of the lower leg is most common. Sometimes, combined compartment syndromes of neighbouring skeletal regions are observed. In this review, the specific clinical symptoms as well as the anatomic and therapeutic characteristics of the acute compartment syndrome of the lower extremity are described.     

Well Leg Compartment Syndrome After Abdominal Surgery

Background

Well leg compartment syndrome (WLCS) is a complication to abdominal surgery. We aimed to identify risk factors for and outcome of WLCS in Denmark and literature.

Methods

Prospectively collected claims to the Danish Patient Compensation Association (DPCA) concerning WLCS after abdominal operations 1996–2013 and cases in literature 1970–2013 were evaluated. Cases of fasciotomy within 2 weeks after abdominal surgery 1999–2008 were extracted from the Danish National Patient Register (DNPR).

Results

There were 40 cases in DPCA and 124 in literature. In 68 % legs were supported under the knees during surgery. Symptoms of WLCS presented within 2 h after surgery in 56 % and in only 3 cases after 24 h. Obesity was not confirmed as risk factor for WLCS. The mean diagnostic delay was 10 h. One-third of fasciotomies were insufficient. The diagnostic delay increased with duration of the abdominal surgery (p = 0.04). Duration of the abdominal surgery was 4 times as important as the diagnostic delay for severity of the final outcome. DNPR recorded 4 new cases/year, and half were reported to DPCA.

Conclusion

The first 24 h following abdominal surgery of >4 h′ duration with elevated legs observation for WLCS should be standard. Pain in the calf is indicative of WLCS, and elevated serum CK can support the diagnosis. Mannitol infusion and acute four-compartment fasciotomy of the lower leg is the treatment. The risk of severe outcome of WLCS increases with duration of the primary operation. A broad support and change of legs’ position during surgery are suggested preventative initiatives.