Kenny Charles
Department of Surgery, Division of Orthopaedic Surgery, Columbia Memorial Hospital, Hudson, New York, USA.
J Trauma. 2006 Oct;61(4):909-12. doi: 10.1097/01.ta.0000224914.03527.01.
Changes in compartment pressures have been noted during traction, reduction, and intramedullary fixation of fractures. Changes in limb length and compartment volumes are suspected contributing factors. Pressure and volume changes are known to be related in animal models. If an acute increase in limb length can adversely affect compartment pressures, reversal or delay of such an increase in length may be of value in the treatment and prevention of compartment syndromes.
A clinical example is presented in which a documented anterior compartment syndrome was successfully treated by deliberate loss of fracture reduction, without fasciotomy. Fracture reduction was later restored when swelling subsided. Anterior compartment pressures were recorded in response to limb length changes in osteotomized cadaver limbs stabilized with external fixation.
The pressure in the anterior compartment varies directly with acute changes in the length of the leg, in an experimental model. Mathematical analysis indicates that available volume within a compartment varies inversely with acute changes in its length.
Fracture reduction that restores the length of an acutely injured extremity may increase pressure in the compartments by decreasing available volume. Deliberate loss of reduction can decrease pressure in the compartments, offering a potential alternative to fasciotomy in the care of compartment syndrome in cautiously selected, monitored patients. Early stabilization without reduction, followed by delayed reduction, may be preferable during treatment of fractures prone to compartment syndrome. Decreased available compartment volume may contribute to compartment syndrome after distraction with intramedullary rods or skeletal traction.
在骨折的牵引、复位及髓内固定过程中已注意到骨筋膜室内压力的变化。肢体长度和骨筋膜室容积的改变被怀疑是促成因素。在动物模型中，压力和容积的变化是相关的。如果肢体长度的急性增加会对骨筋膜室内压力产生不利影响，那么逆转或延迟这种长度增加在骨筋膜室综合征的治疗和预防中可能具有价值。
给出一个临床实例，其中记录在案的前侧骨筋膜室综合征通过故意丢失骨折复位而成功治疗，未行筋膜切开术。肿胀消退后，骨折复位得以恢复。在使用外固定稳定的截骨尸体肢体中，记录前侧骨筋膜室内压力对肢体长度变化的反应。
在实验模型中，前侧骨筋膜室内压力与腿部长度的急性变化直接相关。数学分析表明，骨筋膜室内的可用容积与其长度的急性变化呈反比。
恢复急性损伤肢体长度的骨折复位可能通过减少可用容积而增加骨筋膜室内压力。故意丢失骨折复位可降低骨筋膜室内压力，在谨慎选择、监测的患者中，为骨筋膜室综合征的治疗提供了一种潜在的替代筋膜切开术的方法。在治疗易发生骨筋膜室综合征的骨折时，早期不复位固定，随后延迟复位可能更为可取。使用髓内棒或骨牵引进行牵引后，可用骨筋膜室容积减少可能导致骨筋膜室综合征。
