躯干及肢体大血管损伤的急救体会

目的 总结躯干及肢体大血管损伤救治的经验体会。方法 对37例躯干及四肢大血管损伤病例资料进行回顾性分析，总结其院前急救、手术方法和围手术期处理经验。结果 全组病例中除2例因失血性休克死亡外，其余病例均痊愈，无血管损伤术后并发症。结论 加强基层医院医生在躯干及四肢大血管创伤救治技术上的培训并得以提高，有利于降低大血管损伤的死亡率和致残率。     

骨关节部位四肢主干血管损伤的救治

目的:探讨四肢主干血管于骨关节部位的损伤机制及临床表现特点与治疗方法。方法:回顾7年间36例骨关节部位四肢主干血管损伤的临床诊断过程及治疗效果。结果:自体静脉移植15例,人造血管移植1例,血管吻合13例,血管修补2例,死亡2例,截肢3例(1例上肢,2例下肢)。结论:四肢主干血管在关节部位损伤发生率高,后果严重,救治原则是保全生命基础上尽早修复血管恢复肢体功能。     

四肢大血管损伤出血的急救

四肢大血管损伤是较常见的严重创伤。据统计,1970年以来四肢血管损伤有增多的趋势,约占总创伤的3%。最常见于青年人,男性多于女性。为了挽救此类伤员的生命和肢体,则需紧急救治。本文仅就四肢大血管损伤的一般急救原则,结合自己的体会和文献报告简述如下。     

四肢主要血管损伤72例临床分析

目的探讨四肢主要血管损伤的救治体会。方法总结分析72例四肢主要血管损伤病例。全组手术清创和探查后,针对不同的情况选择血管修复的方法。结果采用血管端端吻合28例(38.9%),血管修补18例(25%),自体静脉移植12例(16.7%),截肢12例(16.7%),死亡2例(2.7%)。结论四肢主要血管损伤救治原则是保证生命安全后,尽快重建血液循环、恢复肢体功能;早诊断、快速救治是关键,快速止血是重点,同时重视对深静脉的修复。     

四肢主要血管急性损伤的显微外科修复

目的 通过对206例四肢主要血管急性损伤病例的诊治分析,探讨提高手术治疗的效果。方法 206例血管损伤应用显微外科技术,直接血管吻合修复117例,静脉移植血管修复46例,单纯修补43例。结果 治愈185例,截肢13例,死亡8例,血管损伤在6h修复,肢体坏死占4.1％,超过12h修复,肢体坏死为21.3％。结论 四肢主要血管急性损伤应尽早手术修复。缺损超过2cm应作静脉移植修复,术后注意骨筋膜间隙综合征的发生并及早切开减压是提高治愈率和降低肢体坏死的关键。     

四肢大血管损伤的治疗

四肢大血管损伤是一种十分严重的损伤,轻者可致残,重者危及生命。因此早期诊断,及时处理,正确修复,才能挽救生命,恢复肢体功能。现将我院1985年以来41例四肢大血管损伤的治疗报告如下:     

创伤并发骨筋膜室综合征的预防与护理

骨筋膜室综合征的病人，发病急、病情危重且发展迅速，可严重影响患肢功能，造成肢体残废，甚至危及生命。总结救治16例骨筋膜室综合征病人的护理体会，认为：四肢创伤后应严密观察生命体征、伤肢疼痛及其性质，观察患处局部感觉、表面皮温并积极治疗原发伤，去除病因，采取有效的预防和护理措施，在严格无菌技术操作下，早期切开减压，减少或杜绝各种诱发因素，尽可能地预防或减轻肢体水肿，是防止伤肢缺血性肌挛缩、肢体坏疽、致残的重要保证。     

四肢主干血管损伤的急诊显微修复

目的 报道四肢主干血管损伤急诊显微修复和治疗的临床效果。方法 应用显微外科技术修复四肢主干血管开放性损伤76例79条血管，手术方法包括受损血管的显露、血管吻合和自体静脉移植术。结果 治愈73例，截肢2例，死亡1例。结论 对四肢主干血管开放性损伤的治疗是应尽快控制出血和恢复肢体血运，应用显微外科技术修复是肢体血液循环重建、肢体保护和功能恢复的保证。     

四肢主要动脉挫伤合并血栓形成12例

目的：探讨四肢主要动脉挫伤合并血栓形成的诊断和治疗方法。方法：对12例四肢主要动脉挫伤合并血栓形成患者,9例行血栓取出、动脉损伤段切除断端吻合术,3例行血栓取出、动脉损伤段切除自体大隐静脉移植术,7例血管修复后行骨筋膜室切开减张术。结果：12例中,8例肢体完全成活,术后恢复良好;1例术后小腿肌肉小部分坏死,遗留轻度跛行;3例截肢。结论：四肢主要动脉挫伤合并血栓形成,早期易漏诊,诊断明确应尽快行血管修复,恢复肢体血运。     

浮膝中血管损伤的诊断和处理

目的：探讨浮膝损伤合并大血管损伤的诊断和处理方法。方法：1994年1月～2001年1月本院共处理浮动膝合并大血管损伤26例，男17例，女9例。年龄12～71岁，平均326岁。血管损伤部位：股动静脉11例，股动脉3例，股浅动脉2例，腘动静脉4例，腘动脉2例，胫前、胫后动脉4例。11例病人行端端吻合术(42．3％)，6例病人行隐静脉移植修复术(23．1％)，2例病人使用聚四氟乙烯(PTFE，polytetrafluoroethylene)进行血管修复(7．7％)，7例病人进行静脉损伤部位的修复(26．9％)。结果：2例为股动静脉和腘动脉损伤合并小腿严重开放性骨折，术后严重感染，行截肢术。1例合并腹腔脏器出血，死于出血性休克。保肢成功率76．9％。所有骨折均在6个月内获得愈合。结论：对浮膝合并血管损伤的患者，应先处理对生命构成威胁的损伤，并进一步明确诊断，适当固定骨折，彻底清创，修复损伤血管，必要时行骨筋膜间室切开术。     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例(52条)四肢血管损伤患者,男35例,女9例,年龄14~58岁,平均27·3岁,分别采用自体血管(42条)和人造血管(10条)移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

周围动脉损伤的治疗

总结周围动脉损伤74例,以上肢和下肢主干动脉为多。其中,行血管端端吻合28例,裂口修补12例,自体静脉移植20例,动脉结扎7例,未探查血管7例。74例中死亡1例,截肢16例。根据本组病例治疗结果,认为动脉损伤后应尽早处理,其方法主要采用血管修复。软组织及血管的彻底清创,良好的修复技术,骨折妥善固定,彻底止血,与动脉伴行的主干静脉的探查与修复,远端肢体筋膜充分减压,恰当引流以及术中术后局部及全身抗凝剂的应用对治疗动脉损伤均十分重要。     

血管移植在四肢血管损伤中的应用

目的:探讨血管移植在四肢血管损伤中的作用。方法:44例（52条）四肢血管损伤患者,男35例,女9例,年龄14⁵8岁,平均27·3岁,分别采用自体血管（42条）和人造血管（10条）移植。结果:截肢3例,人工血管移植物感染行股浅-静脉原位置换2例,肢体缺血挛缩6例,神经功能恢复不完全7例。其余移植血管均通畅,远端肢体血循环良好。结论:血管移植治疗血管损伤保肢成功率高;治疗中须注意早诊断、早修复、严格显微外科原则、积极行骨筋膜室切开减压。     

Tissue pressure and perfusion in the compartment syndrome

Three objective indicators of the need for muscle compartment decompression were evaluated in an animal model and in clinical studies.In the animal model, there was linear correlation between compartment pressure and graded external counterpressure (r = 0.99, p < 0.001) and between decreasing MBF and increasing compartment pressure (r = -0.85, p < 0.01). MBF was undetectable with external counterpressure greater than 80 mm Hg.In patients, Doppler evaluation of distal arteries was an inconsistent guide for compartment decompression. There was correlation between MBF and the difference between diastolic blood pressure and compartment pressure (r = 0.66, p < 0.05). All patients requiring decompression had MBF values less than 1 cc/min/100g.Determination of MBF and/or compartment pressure appear to be useful early indicators of the need for compartment decompression.     

Endoscopic-assisted Fascial Decompression for Forearm Exertional Compartment Syndrome: A Case Report and Review of the Literature

A case of chronic exertional compartment syndrome of the forearm treated with endoscopic-assisted fascial decompression is presented. The diagnosis of exertional compartment syndrome of the forearm was confirmed by direct measurement of intracompartmental pressures. Following endoscopic-assisted fascial decompression, the patient was able to begin rehabilitation therapy within 2 weeks. There were no wound-related complications. The patient reported no recurrence of symptoms after returning to work requiring heavy lifting, and morbidity associated with open decompression was avoided. Endoscopic release is not an option in traumatic compartment syndrome, but a minimally invasive approach may be considered in cases of exertional compartment syndrome. Reports of endoscopic-assisted fascial decompression in exertional compartment syndrome of the forearm are relatively scarce. Confirmation of the safety and efficacy of these evolving techniques in the hand surgery literature remains important.     

Pelvic compartment syndrome: a systematic review

Bilateral ureteral obstruction due to traumatic pelvic haematoma and increased pressure in the retroperitoneal space constitute an acute pelvic compartment syndrome. We systematically reviewed the available evidence concerning pelvic compartment syndrome using an online search of the MEDLINE databases OVID and PubMed. There were nine cases of pelvic compartment syndrome. A motor vehicle accident was the most frequent cause of pelvic compartment syndrome. Diagnosis was made using clinical and radiological methods in all cases. Treatment was by surgical decompression in 88% of cases. Observed complications were neurological deficits (44%), muscle atrophy (33%), and renal failure (33%). Pelvic compartment syndrome is as serious as the more common compartment syndromes, requiring high vigilance for diagnosis and surgical decompression for treatment.     

足部骨筋膜室综合征早期诊断与治疗

目的:探讨足部骨筋膜室综合征早期诊断与治疗结果。方法:1998年1月-2003年12月收治15例足骨筋膜室综合征患者(均为男性:年龄15～55岁,平均32岁),行足背双切口减压4例,足底内侧减压9例,足内外两侧减压2例。1周后行减张缝合或植皮术。结果:15例随访9～24个月,12例恢复佳,足运动感觉正常;2例有足底感觉减退、足趾麻木;1例遗留前足挛缩、无力,足趾麻木。无爪形趾及功能障碍者。结论:足损伤后,Whiteside法测定组织间隙压力是诊断足骨筋膜室综合征的可靠方法。治疗时足部如有骨折、血肿者,骨筋膜室减张切口,宜选择足底内侧切开效果较好。     

经皮深筋膜切开减压治疗早期骨筋膜室综合征

目的：探讨治疗早期骨筋膜室综合征的方法和疗效。方法：在测压机监测下经皮切开深筋膜减压。结果：28例中25例减压效果良好，3例术后骨筋膜室压力逐渐增高而改用传统的广泛切开减压术治疗。结论：该方法操作简单，使用安全，是治疗早期骨筋膜综合征较好的手术方法。     

N-acetylcysteine Protects Striated Muscle in a Model of Compartment Syndrome

Background

To avoid ischemic necrosis, compartment syndrome is a surgical emergency treated with decompression once identified. A potentially lethal, oxidant-driven reperfusion injury occurs after decompression. N-acetylcysteine is an antioxidant with the potential to attenuate the reperfusion injury.

Questions/purposes

We asked whether N-acetylcysteine could preserve striated muscle contractility and modify neutrophil infiltration and activation after simulated compartment syndrome release.

Materials and Methods

Fifty-seven rats were randomized to control, simulated compartment syndrome, and simulated compartment syndrome plus N-acetylcysteine groups. We isolated the rodent cremaster muscle on its neurovascular pedicle and placed it in a pressure chamber. Chamber pressure was elevated above critical closing pressure for 3 hours to simulate compartment syndrome. Experiments were concluded at three times: 1 hour, 24 hours, and 7 days after decompression of compartment syndrome. We assessed twitch and tetanic contractile function and tissue myeloperoxidase activity. Ten additional rats were randomized to control and N-acetylcysteine administration after which neutrophil respiratory burst activity was assessed.

Results

The simulated compartment syndrome decreased muscle contractility and increased muscle tissue myeloperoxidase activity compared with controls. Treatment with N-acetylcysteine preserved twitch and tetanic contractility. N-acetylcysteine did not alter neutrophil infiltration (myeloperoxidase activity) acutely but did reduce infiltration at 24 hours, even when given after decompression. N-acetylcysteine reduced neutrophil respiratory burst activity.

Conclusion

N-acetylcysteine administration before or after simulated compartment syndrome preserved striated muscle contractility, apparently by attenuating neutrophil activation and the resultant oxidant injury.

Clinical Relevance

Our data suggest a potential role for N-acetylcysteine in the attenuation of muscle injury after release of compartment syndrome and possibly in the prophylaxis of compartment syndrome.     

早期切开减压并螺钉固定治疗Lisfranc损伤并足骨筋膜室综合征

目的:探讨早期切开减压并螺钉固定治疗Lisfranc损伤并足骨筋膜室综合征的临床疗效.方法:回顾性分析2017年1月至2018年12月收治的5例Lisfranc损伤并足部骨筋膜室综合征患者的临床资料,其中男4例,女1例;年龄19～62岁.均为闭合性损伤.受伤至就诊时间1～14h.根据Myerson分型法,A型1例,B型...