手部急性骨筋膜室综合征的分型及治疗

目的探讨手部急性骨筋膜室综合征（osteofascial compartment syndrome OCS）的分型及治疗方法。方法对我院收治的24例手部急性OCS的病例资料进行总结。将手部OCS按病变发生范围分四型。Ⅰ型（3例）：病变发生局限于三个以内骨筋膜间室。Ⅱ型（8例）：病变发生于三个以上骨筋膜间室，累及大部分手内肌。Ⅰ、Ⅱ型均将发生病变的筋膜间室取独立切口切开减压。Ⅲ型（4例）：病变发生于三个以上骨筋膜间室，并发掌中间区内动脉弓等组织损伤，形成区室内高压。必须将发生病变的筋膜间室和掌中间区同时切开减压；Ⅳ型（9例）：病变发生于三个以上骨筋膜间室，甚或有掌中间区内高压，并发急性腕管综合征。在手部筋膜间室、掌中间区切开减压后，同时行腕管减压术。结果随访时间6周～1．5年，按黄悦等手腕部OCS疗效的评定标准评定：优17例，良4例，中2例，差1例，优良率87．5％。结论将手部急性OCS按病变发生范围分型，有利于切开减压术式的选择。

Classification and treatment of acute osteofascial compartment syndrome of hand

Objective To investigate the classification and treatment of acute osteofascial compartment syndrome （OCS） of the hand.Methods 24 cases with acute OCS of the hand were treated in our hospital were followed and analyzed. The cases were divided into four types according to the areas of the injury. Type Ⅰ （3 cases）： the areas of the injury were within 3 osteofascial compartments. Type Ⅱ （8 cases）： the areas of the injury were more than 3 osteofascial compartments, and the most functions of the hand muscles were impaired. In the cases of type Ⅰ and Ⅱ ,the pressure were decreased thoroughly by dissecting every diseased osteofascial compartments. Type Ⅲ （4 cases）： the areas of the injury were more than 3 osteofascial compartments, and the tissue such as palmar arch in the midpalmar region were injuried at the same time. Such factors led to the elevated intracompartmental pressure. And it was necessary to release the midpalmar region as well as the diseased osteofascial compartments. Type Ⅳ （9 case）： the areas of the injury were more than 3 osteofascial compartments, and the carpal tunnel syndrome occurred at the same time, with the elevated pressure of the midpalmar region sometimes. The carpal tunnel decompression operation was followed after releasing the osteofascial compartment and the midpalmar region.Results Postoperative followed-up ranged from 6 weeks to 18 months. According to the functional evaluation criteria of osteofascial compartment syndrome of the hand issued by Huang, the result was excellent in 17, good in 4, fair in 2,poor in 1,with excellent and good rate 87.5%.Conclusion To classify the acute osteofascial compartment syndrome according to the areas of the injury is advantageous to choose the way of decompression operations.