Heemskerk V H, Hulsewé K W E, Stroeken H J G, Hoofwijk A G M
Maaslandziekenhuis, afd. Chirurgie, Walramstraat 23, 6131 BK Sittard.
Ned Tijdschr Geneeskd. 2004 Nov 6;148(45):2235-40.
Two 37-year-old men, both drug addicts, and a 32-year-old homeless woman presented themselves with a painful arm. Except for the first patient, there was a delay in diagnosing the compartment syndrome of the arm. In the first patient emergency fasciotomy led to a good functional recovery, however kidney function was lost despite proper treatment, possibly due to combined heroine use and muscle breakdown. In the second patient prolonged immobility and altered consciousness by drug use should have increased clinical suspicion. Poor arm function remained even after fasciotomy. In the third patient inadequate clinical examination delayed surgery. Major early symptoms of compartment syndrome are progressive disproportional pain and sensory loss, not relieved by analgesia. If left untreated, the ischaemic tissue damage is potentially limb and even life threatening. The acute compartment syndrome is a clinical diagnosis and a low threshold for surgical exploration and fasciotomy is advocated.
两名37岁的男子，均为吸毒者，以及一名32岁的无家可归妇女因手臂疼痛前来就诊。除第一名患者外，其他患者的手臂骨筋膜室综合征诊断均有延迟。第一名患者接受急诊筋膜切开术后功能恢复良好，但尽管治疗得当，仍出现肾功能丧失，可能是由于同时使用海洛因和肌肉分解所致。第二名患者因吸毒导致长时间不动和意识改变，这本应增加临床怀疑。即使在筋膜切开术后，手臂功能仍较差。第三名患者临床检查不充分导致手术延迟。骨筋膜室综合征的主要早期症状是进行性不成比例的疼痛和感觉丧失，镇痛无法缓解。如果不治疗，缺血性组织损伤可能会危及肢体甚至生命。急性骨筋膜室综合征是一种临床诊断，主张对手术探查和筋膜切开术保持较低阈值。
