Beraldo Stefania, Dodds Simon R
Department of Vascular Surgery, Good Hope Hospital NHS Trust, Rectory Road, Sutton Coldfield, B75 7RR, West Midlands, United Kingdom.
Dis Colon Rectum. 2006 Nov;49(11):1772-80. doi: 10.1007/s10350-006-0712-1.
Acute compartment syndrome in patients undergoing prolonged colorectal procedures is uncommon but can have catastrophic consequences for the patient with the development of metabolic acidosis, myoglobinuric renal failure, Volkmann's contracture, limb loss, and death. The potential to produce long-term disability in a patient has important medicolegal implications, particularly if the complication is avoidable. Why only some patients develop acute compartment syndrome is not fully understood. The purpose of this study was to highlight current knowledge and suggested prevention strategies.
A review of the relevant English language articles was performed on the basis of a MEDLINE search of the keywords: acute compartment syndrome, lithotomy position, reperfusion injury, and fasciotomy.
Different factors play a role: lithotomy position with or without head down, ankle and knee position, external compression for deep vein thrombosis prophylaxis, method of leg support, duration of surgery, and physiologic factors, such as gender, age, and body mass index. All efforts should be directed to prevent the establishment of acute compartment syndrome and there are accepted suggestions, such as limiting the time of leg elevation, positioning the leg below the atrium level, and monitoring postoperatively patients at risk. There is still debate on the intraoperative use of pulse oximetry to detect hypoperfusion and the appropriate use of sequential compression devices and antithromboembolic stockings.
Acute compartment syndrome is uncommon but cases have been reported after prolonged pelvic procedures in the lithotomy position and it is a preventable condition. More research is required to set clear guidelines on patient positioning during surgery.
在接受长时间结直肠手术的患者中，急性筋膜室综合征并不常见，但一旦发生，可能会给患者带来灾难性后果，包括代谢性酸中毒、肌红蛋白尿性肾衰竭、Volkmann挛缩、肢体缺失甚至死亡。患者出现长期残疾的可能性具有重要的法医学意义，尤其是如果这种并发症是可以避免的。为何只有部分患者会发生急性筋膜室综合征，目前尚不完全清楚。本研究旨在强调现有知识及建议的预防策略。
基于对MEDLINE数据库中关键词“急性筋膜室综合征”“截石位”“再灌注损伤”和“筋膜切开术”的检索，对相关英文文献进行综述。
多种因素发挥作用：有无头低的截石位、踝关节和膝关节位置、用于预防深静脉血栓形成的外部压迫、腿部支撑方法、手术时长以及生理因素，如性别、年龄和体重指数。所有努力都应致力于预防急性筋膜室综合征的发生，目前已有一些公认的建议，如限制腿部抬高时间、将腿部置于心房水平以下以及对有风险的患者进行术后监测。关于术中使用脉搏血氧饱和度测定法检测灌注不足以及序贯加压装置和抗血栓栓塞弹力袜的恰当使用，仍存在争议。
急性筋膜室综合征并不常见，但有报道称在长时间截石位盆腔手术后出现了相关病例，且这是一种可预防的情况。需要更多研究来制定关于手术期间患者体位的明确指南。
