Vandervelpen G, Goris L, Broos P L, Rommens P M
Afdeling Traumatologie en Spoedgevallenheelkunde, Universitair Ziekenhuis Gasthuisberg, Leuven.
Acta Chir Belg. 1992 Sep-Oct;92(5):234-40.
In a retrospective study on 28 patients, the incidence, nature and severity of the sequelae after severe lower leg trauma were studied. All patients had a tibial shaft fracture with a complete or impending compartment syndrome, treated with an urgent stabilisation and an adequate decompressive fasciotomy. In a thorough clinical examination, performed 17 months after trauma, the mobility of the knee and ankle joint, the perimetry of the lower leg and foot, and the muscle strength of all lower leg muscles were measured. Contractures were noticed, superficial sensibility was tested and an evaluation of march was done. More than one fourth of the patients showed late functional disabilities, mainly because of limitation of the dorsiflexion of the ankle joint, reduction of the muscle strength of the foot extensors, contractures of the foot flexors and abnormal superficial sensibility. The more severe the primary soft tissue trauma was, the more severe the functional disabilities were. The severity of the soft tissue damage, resulting from the trauma itself, is the most important factor for the late functional result after lower leg trauma. The compartment syndrome is certainly an aggravating factor when it is not treated by urgent fasciotomy. But this does not mean that all patients with lower leg fracture and compartment syndrome, treated with urgent fasciotomy, will show excellent functional end results.
在一项针对28例患者的回顾性研究中，对严重小腿创伤后的后遗症发生率、性质和严重程度进行了研究。所有患者均为胫骨干骨折并伴有完全或即将发生的骨筋膜室综合征，均接受了紧急固定和充分的减压筋膜切开术治疗。在创伤后17个月进行的全面临床检查中，测量了膝关节和踝关节的活动度、小腿和足部的视野、以及所有小腿肌肉的肌力。记录挛缩情况，测试浅感觉，并进行行走评估。超过四分之一的患者出现晚期功能障碍，主要原因是踝关节背屈受限、足部伸肌肌力下降、足部屈肌挛缩和异常的浅感觉。原发软组织创伤越严重，功能障碍就越严重。创伤本身导致的软组织损伤严重程度是小腿创伤后晚期功能结果的最重要因素。当骨筋膜室综合征未通过紧急筋膜切开术治疗时，它肯定是一个加重因素。但这并不意味着所有接受紧急筋膜切开术治疗的小腿骨折和骨筋膜室综合征患者都会有良好的功能最终结果。
