Moed B R, Strom D E
Department of Orthopaedic Surgery, Wayne State University School of Medicine, Detroit, Michigan.
J Orthop Trauma. 1991;5(1):71-7. doi: 10.1097/00005131-199103000-00013.
Two patients developed an anterior tibial compartment syndrome after closed reamed intramedullary nailing of their fractured tibial shaft. Subsequently, a study was undertaken using a canine model to evaluate the risk of compartment syndrome after this operative procedure. A closed tibial fracture was created in 20 mongrel canines by applying a torsional load localized to the tibial shaft through a stress riser made with an intramedullary drill. Compartment pressures were measured in the canine anterolateral and deep posterior leg compartments. In 10 dogs, closed intramedullary nailing with reaming was performed while compartment pressures were measured. The remaining 10 dogs served as controls. Compartment pressures were monitored for 4 hours. In the experimental group, one dog attained and maintained a pressure greater than 50 mm Hg; a second dog maintained a pressure of 20 mm Hg during the postoperative monitoring period. In both of these cases, fasciotomy reduced the pressures to zero. The high tissue pressure readings were localized to the anterolateral muscle compartment. In the control group, no pressures higher than 8 mm Hg were recorded. Compartment syndrome is a potential complication of closed intramedullary nailing of the tibia, and the anterior muscle compartment appears to be the one most at risk. Therefore, perioperative tissue pressure monitoring is recommended.
两名患者在胫骨干骨折行闭合扩髓髓内钉固定术后发生了胫前肌间隔综合征。随后，采用犬类模型进行了一项研究，以评估该手术操作后发生肌间隔综合征的风险。通过髓内钻制造应力集中器，对20只杂种犬的胫骨干施加扭转负荷，造成闭合性胫骨骨折。测量犬类小腿前外侧和后深肌间隔的压力。对10只犬在测量肌间隔压力的同时进行闭合髓内钉扩髓术。其余10只犬作为对照。监测肌间隔压力4小时。在实验组，一只犬的压力达到并维持在大于50 mmHg；另一只犬在术后监测期压力维持在20 mmHg。在这两种情况下，筋膜切开术使压力降至零。高组织压力读数局限于前外侧肌间隔。在对照组中，记录到的压力均不高于8 mmHg。肌间隔综合征是胫骨闭合髓内钉固定术的一种潜在并发症，前肌间隔似乎是最易受累的部位。因此，建议进行围手术期组织压力监测。
