Szalay G, Meyer C, Alt V, Heiss C, Schnettler R, Hackethal A
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Giessen, Giessen und Marburg, Deutschland.
Zentralbl Chir. 2010 Apr;135(2):163-7. doi: 10.1055/s-0029-1224706. Epub 2010 Apr 8.
The positioning-related compartment syndrome of the lower leg after long-duration operations in the lithotomy position -represents a rare complication. The aim of this retrospective study was to draft recommendations to avoid this rare complication by reviewing the cases with positioning-related compartment syndromes in our own patient data. PATIENTS / MATERIAL AND METHODS: From January 1996 to February 2009, 3 women and 1 man with an average age of 38 years (24 to 55 years) were treated with a medial and lateral dermatofasciotomy with opening of lower leg loges due to a clinically manifested compartment syndrome of the -lower leg after long-duration operations in the -lithotomy position.
In all 4 patients a dermatofasciotomy with opening of the lower leg compartments could -avoid considerable secondary damage of the limb. A long-duration lithotomy position in connection with obesity, a low positioning of the head as well as nicotine abuse are only some of the risk factors contributing to the development of a positioning-related compartment syndrome. An epidural anaesthesia bears the risk of a protracted diagnosis.
The positioning-related compartment syndrome represents a rare but considerable complication after long-duration operations in the -lithotomy position. It is a clinical complication and the inducing and exponentiation risk factors as well as the clinical symptoms should be known by the treating team. If the operation time is expected to be longer than 3 hours, we recommend written information to the patient concerning this complication. Consequent postoperative controls of risk patients are obligatory. An epidural anaesthesia bears the risk of a protracted diagnosis. In the case of suspected compartment syndrome we recommend early dermatofasciotomy in order to avoid -irreversible damage to the limb.
在截石位进行长时间手术后出现的小腿与体位相关的骨筋膜室综合征是一种罕见的并发症。本回顾性研究的目的是通过回顾我们自己患者数据中与体位相关的骨筋膜室综合征病例，起草避免这种罕见并发症的建议。
患者/材料与方法：1996年1月至2009年2月，3名女性和1名男性，平均年龄38岁（24至55岁），因在截石位进行长时间手术后临床表现为小腿骨筋膜室综合征，接受了小腿内侧和外侧皮肤筋膜切开术并打开小腿筋膜间隙。
在所有4例患者中，小腿筋膜间隙切开的皮肤筋膜切开术避免了肢体相当大的继发性损伤。长时间的截石位加上肥胖、头部低位以及吸烟仅是导致与体位相关的骨筋膜室综合征发生的部分危险因素。硬膜外麻醉存在诊断延迟的风险。
与体位相关的骨筋膜室综合征是截石位长时间手术后一种罕见但严重的并发症。这是一种临床并发症，治疗团队应了解诱发和加重的危险因素以及临床症状。如果预计手术时间超过3小时，我们建议向患者书面告知这一并发症。对高危患者进行术后持续监测是必要的。硬膜外麻醉存在诊断延迟的风险。对于疑似骨筋膜室综合征的情况，我们建议早期进行皮肤筋膜切开术以避免肢体不可逆转的损伤。
