Boland Michael R, Heck Chris
Department of Orthopedic Surgery, University of Kentucky College of Medicine, Lexington, Kentucky 40536, USA.
Orthopedics. 2009 Mar;32(3):218. doi: 10.3928/01477447-20090301-03.
Acute compartment syndrome of the thigh is rare due to the space's ability to accommodate large volumes of fluid and, with the exception of the lateral septum, its thin compliant linings. This article describes a case of bilateral exercise-induced severe compartment syndrome treated with anterior and posterior fasciotomies. A 29-year-old man was admitted to intensive care with myoglobinuria. His left thigh was evaluated 18 hours later for compartment syndrome. The patient reported that 14 hours prior to initial presentation, he had participated in a 1-hour session of vigorous basketball. He gradually developed bilateral moderately severe thigh pain and tea-colored urine. Physical examination revealed pain secondary to passive stretch of both knees at 20 degrees flexion, plus firm anterior and posterior compartments to palpation. A handheld pressure monitor revealed the following compartment pressures: left anterior 80 mm Hg; left posterior 75 mm Hg; right anterior 45 mm Hg; and right posterior 50 mm Hg. Bilateral emergent anterior and posterior compartment fasciotomies were performed. The patient developed a significant severe distal motor and sensory neurological deficit on the left side, which recovered to 3/5 motor strength and protective sensation. At 6-month follow-up, he ambulated with the assistance of a left ankle foot orthosis. Acute severe compartment syndrome can occur following vigorous exercise. We recommend fasciotomies after exercise-induced acute compartment syndrome rather than initial observation because of the severity of morbidity associated with undertreated compartment syndrome.
由于大腿间隙能够容纳大量液体，且除外侧间隔外其衬里薄且有顺应性，大腿急性骨筋膜室综合征较为罕见。本文描述了一例双侧运动诱发的严重骨筋膜室综合征，采用前后筋膜切开术进行治疗。一名29岁男性因肌红蛋白尿入住重症监护病房。18小时后对其左大腿进行骨筋膜室综合征评估。患者报告在初次就诊前14小时，他参加了1小时的剧烈篮球运动。他逐渐出现双侧中度严重的大腿疼痛和茶色尿。体格检查发现，双膝关节在20度屈曲时被动伸展引起疼痛，且触诊时前后骨筋膜室坚硬。手持式压力监测仪显示以下骨筋膜室内压力：左前80毫米汞柱；左后75毫米汞柱；右前45毫米汞柱；右后50毫米汞柱。遂进行双侧紧急前后骨筋膜室切开术。患者左侧出现严重的远端运动和感觉神经功能缺损，恢复至3/5肌力和保护性感觉。在6个月的随访中，他借助左脚踝足矫形器行走。剧烈运动后可发生急性严重骨筋膜室综合征。由于未治疗的骨筋膜室综合征相关发病率较高，我们建议在运动诱发的急性骨筋膜室综合征后进行筋膜切开术而非初始观察。
