Harris Ian A, Kadir Agus, Donald Geoff
Department of Orthopaedic, Liverpool Hospital, Liverpool, NSW, Australia.
J Trauma. 2006 Jun;60(6):1330-5; discussion 1335. doi: 10.1097/01.ta.0000196001.03681.c3.
Compartment syndrome is common in acute fractures of the tibia. Early diagnosis is important, as delayed treatment leads to significant complications. Continuous compartment pressure monitoring has been recommended to prevent late diagnosis of compartment syndrome associated with tibia fractures. In this study, we aim to examine the effect of continuous compartment pressure monitoring on outcome in acute tibia fractures.
We randomized 200 consecutive acute extra-articular tibia fractures into monitored and nonmonitored groups. The monitored group received continuous compartment pressure for 36 hours and the nonmonitored group received usual postoperative observations. In alert patients, the diagnosis of compartment syndrome was made clinically. In unconscious patients, a difference between compartment pressure and diastolic blood pressure (DeltaP) of less than 30 mm Hg was the criteria for fasciotomy. Patients were assessed for late sequelae of compartment syndrome (sensory loss, muscle weakness, contracture, and toe clawing) at 6 months.
Eighty-nine percent of patients were followed up for a minimum of 6 months or to fracture union. There were five cases of compartment syndrome in the nonmonitored group and none in the monitored group. At 6 months, the complication rates and late sequelae in both groups were not significantly different. In the monitored group, there were 18 patients with DeltaP less than 30 mm Hg, none of whom developed compartment syndrome or late sequelae. In both groups, patients with high energy or open fractures had significantly more late sequelae.
Continuous compartment pressure monitoring is not indicated in alert patients who are adequately observed.
骨筋膜室综合征在胫骨急性骨折中很常见。早期诊断很重要，因为治疗延迟会导致严重并发症。建议进行连续骨筋膜室压力监测以防止与胫骨骨折相关的骨筋膜室综合征的漏诊。在本研究中，我们旨在研究连续骨筋膜室压力监测对急性胫骨骨折预后的影响。
我们将200例连续的急性关节外胫骨骨折患者随机分为监测组和非监测组。监测组接受36小时的连续骨筋膜室压力监测，非监测组接受常规术后观察。对于意识清醒的患者，通过临床诊断骨筋膜室综合征。对于昏迷患者，骨筋膜室压力与舒张压之差（DeltaP）小于30mmHg是进行筋膜切开术的标准。在6个月时评估患者骨筋膜室综合征的晚期后遗症（感觉丧失、肌肉无力、挛缩和爪形趾）。
89%的患者接受了至少6个月的随访或直至骨折愈合。非监测组有5例骨筋膜室综合征，监测组无。在6个月时，两组的并发症发生率和晚期后遗症无显著差异。在监测组中，有18例患者的DeltaP小于30mmHg，这些患者均未发生骨筋膜室综合征或晚期后遗症。在两组中，高能或开放性骨折患者的晚期后遗症明显更多。
对于得到充分观察的意识清醒患者，无需进行连续骨筋膜室压力监测。
