Frink Michael, Klaus Annie-Kathrin, Kuther Gerald, Probst Christian, Gosling Thomas, Kobbe Philipp, Hildebrand Frank, Richter Martinus, Giannoudis Peter V, Krettek Christian, Pape Hans-Christoph
Department of Traumatology, Hannover Medical School, Carl-Neuberg-Str 1, Hannover, Germany.
Injury. 2007 May;38(5):607-13. doi: 10.1016/j.injury.2006.12.021. Epub 2007 Feb 15.
Acute compartment syndrome represents a severe complication after trauma of the lower extremity. To date, there is limited knowledge about the outcome of compartment syndrome of the lower limb in patients with multiple injuries. We hypothesised that multiple injuries worsen the long term results of compartment syndrome of the lower leg. Patients who underwent fasciotomy for established compartment syndrome of the lower leg from 1999 to 2004 in our level 1 trauma centre were included. Demographic data, additional injuries (Injury Severity Score) and method of treatment were analysed. Outcome assessments included clinical examination and isokinetic strength testing of plantar flexion and dorsal extension at two different angular velocities (60 degrees /s; 120 degrees /s). The mean age was 38.0+/-4.4 years at the time of injury; males were affected twice as often as females. The mean ISS of patients with multiple injuries was 20.2+/-2.3 points. The time between admission and surgical treatment of compartment syndrome was extended in patients with multiple injuries (38.6+/-13.8h versus 13.2+/-3.8h; p=0.04). At follow-up, 15.4% of all patients complained of pain at rest and 26.9% reported pain on exertion. A significant reduction of torque and work was found in the dorsal extensors on the injured side (p<0.05). Polytraumatised patients did not show extended weakness compared to those with isolated injuries. No difference was seen between the two groups regarding pain and function. Polytraumatised patients did not suffer from worse long term effects regarding sensory or motor deficits. Associated injuries did not seem to influence the outcome of the compartment syndrome.
急性骨筋膜室综合征是下肢创伤后的一种严重并发症。迄今为止，对于多发伤患者下肢骨筋膜室综合征的预后了解有限。我们推测，多发伤会使小腿骨筋膜室综合征的长期预后变差。纳入了1999年至2004年在我们的一级创伤中心因确诊的小腿骨筋膜室综合征而接受筋膜切开术的患者。分析了人口统计学数据、其他损伤情况（损伤严重程度评分）及治疗方法。结局评估包括临床检查以及在两种不同角速度（60度/秒；120度/秒）下对跖屈和背伸进行等速肌力测试。受伤时的平均年龄为38.0±4.4岁；男性受影响的频率是女性的两倍。多发伤患者的平均损伤严重程度评分为20.2±2.3分。多发伤患者骨筋膜室综合征入院至手术治疗的时间延长（38.6±13.8小时对13.2±3.8小时；p = 0.04）。在随访时，所有患者中有15.4%主诉静息时疼痛，26.9%报告活动时疼痛。发现受伤侧背伸肌的扭矩和做功显著降低（p<0.05）。与单纯受伤的患者相比，多发伤患者并未表现出更明显的肌无力。两组在疼痛和功能方面未见差异。多发伤患者在感觉或运动功能缺损方面并未遭受更差的长期影响。合并损伤似乎并未影响骨筋膜室综合征的预后。
