Weber O, Kabir K, Goost H, Wirtz D C, Burger C
Klinik für Orthopädie und Unfallchirurgie, Universitätsklinik Bonn.
Z Orthop Unfall. 2008 Mar-Apr;146(2):261-3. doi: 10.1055/s-2007-965804.
The lower leg compartment syndrome is in most cases a post-traumatic soft tissue complication. Nevertheless, it can also occur in a primarily not injured calf, due to external muscle compression during lithotomy positioning. This complication is seen rarely after gynaecological, urological or abdominal operations performed in the Lloyd-Davis position.
We present a case of calf compartment after prolonged lithotomy position of the uninjured leg during the nailing of a femur shaft fracture.
Postoperatively a diffuse turgor of the healthy calf was seen. The compartment pressures were elevated and the enzyme creatine kinase was elevated up to 3000 U/l. After dermatofasciotomy the enzyme level normalised, but in the further course we had to resect the necrotic peroneal muscle compartment.
During operative procedures at the coxal femur, it is necessary to deposit the other leg in the lithotomy postion. By this means, the compartment pressures can increase in the calf muscles to critical values. Together with operation times longer than 4 hours and a high ponderosity a bedding compartment can develop. As it is in the assumed "healthy" leg, this syndrome can be overseen, especially in sedated patients. It has to be considered with high creatine kinase levels and the typical risk factors. If a compartment syndrome is suspected, we recommend early dermatofasciotomy, as this is a low-risk and low-complication operation, in comparison to a later performed compartment decompression. By extending both legs, especially in risky patients, the surgeon can avoid this dangerous complication.
小腿骨筋膜室综合征在大多数情况下是一种创伤后软组织并发症。然而，由于截石位时外部肌肉受压，它也可能发生在最初未受伤的小腿。在采用劳埃德 - 戴维斯体位进行的妇科、泌尿科或腹部手术后，这种并发症很少见。
我们报告一例在股骨干骨折髓内钉固定术期间未受伤的腿长时间处于截石位后发生小腿骨筋膜室综合征的病例。
术后可见健康小腿弥漫性肿胀。骨筋膜室内压力升高，肌酸激酶水平升高至3000 U/l。行皮肤筋膜切开术后酶水平恢复正常，但在后续过程中我们不得不切除坏死的腓骨肌骨筋膜室。
在股骨近端手术过程中，有必要将另一条腿置于截石位。通过这种方式，小腿肌肉的骨筋膜室内压力可升高至临界值。再加上手术时间超过4小时且患者肥胖，可能会形成骨筋膜室综合征。由于它发生在假定“健康”的腿上，这种综合征可能被忽视，尤其是在镇静患者中。当肌酸激酶水平升高且存在典型危险因素时必须予以考虑。如果怀疑有骨筋膜室综合征，我们建议早期行皮肤筋膜切开术，因为与后期进行的骨筋膜室减压相比，这是一种低风险、低并发症的手术。通过伸展双腿，尤其是在高危患者中，外科医生可以避免这种危险的并发症。
