Verleisdonk E J M M, van der Werken Chr
Universitair Medisch Centrum, afd. Heelkunde, Heidelberglaan 100, 3584 CX Utrecht.
Ned Tijdschr Geneeskd. 2004 Nov 6;148(45):2205-9.
After some considerable delay, acute compartment syndrome of the lower leg was diagnosed in a 17-year-old man, a 32-year-old man and a 76-year-old woman. The first patient was an accident victim whose leg was continuously bandaged for three days following treatment of a complicated femur fracture and lower leg wounds, so that inspection was not possible. In the second patient who was also an accident victim, the haemodynamics and the neurological condition initially required so much attention that the compartment syndrome was only noticed after 48 hours. The woman presented with a cold, painful left foot. She had atrial fibrillations. A thrombus mass was removed endovascularly from the femoral artery. She controlled her own pain medication by means of an epidural catheter, but as a result of that a reperfusion compartment syndrome was only noticed at a later stage. These cases reveal that it can be very difficult to establish the diagnosis of acute compartment syndrome, especially if this is masked by the already quite subjective symptoms of the clinical picture. The consequences of a missed compartment syndrome are serious, with a considerable impairment of the limb concerned that often necessitates amputation. Awareness and healthy suspicion are the keys to a quick and timely diagnosis. Prophylactic fasciotomies must be carried out on the basis of several clear indications.
经过相当长的延迟后，一名17岁男性、一名32岁男性和一名76岁女性被诊断为小腿急性骨筋膜室综合征。第一名患者是一名事故受害者，在治疗复杂的股骨骨折和小腿伤口后，其腿部连续包扎了三天，因此无法进行检查。第二名患者也是一名事故受害者，最初其血流动力学和神经状况需要密切关注，以至于骨筋膜室综合征在48小时后才被发现。该女性表现为左脚发冷、疼痛。她患有心房颤动。通过血管内介入从股动脉取出了血栓块。她通过硬膜外导管自行控制疼痛药物，但结果是在后期才发现再灌注骨筋膜室综合征。这些病例表明，急性骨筋膜室综合征的诊断可能非常困难，尤其是当其被临床表现中本就较为主观的症状掩盖时。漏诊骨筋膜室综合征的后果很严重，相关肢体将受到相当大的损害，常常需要截肢。意识和合理怀疑是快速及时诊断的关键。预防性筋膜切开术必须基于几个明确的指征进行。
