儿童腿部急性创伤性间隔综合征：诊断与预后。
Acute traumatic compartment syndrome of the leg in children: diagnosis and outcome.
机构信息
Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Richard D. Wood Center, 2nd Floor, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA.
出版信息
J Bone Joint Surg Am. 2011 May 18;93(10):937-41. doi: 10.2106/JBJS.J.00285.
BACKGROUND
Currently, the most common clinical scenario for compartment syndrome in children is acute traumatic compartment syndrome of the leg. We studied the cause, diagnosis, treatment, and outcome of acute traumatic compartment syndrome of the leg in children.
METHODS
Forty-three cases of acute traumatic compartment syndrome of the leg in forty-two skeletally immature patients were collected from two large pediatric trauma centers over a seventeen-year period. All children with acute traumatic compartment syndrome underwent fasciotomy. The mechanism of injury, date and time of injury, time to diagnosis, compartment pressures, time to fasciotomy, and outcome at the time of the latest follow-up were recorded.
RESULTS
Thirty-five (83%) of the forty-two patients were injured in a motor-vehicle accident and sustained tibial and fibular fractures. The average time from injury to fasciotomy was 20.5 hours (range, 3.9 to 118 hours). In general, the functional outcome was excellent at the time of the latest follow-up. No cases of infection were noted when fasciotomy was performed long after the injury. At the time of the latest follow-up, forty-one (95%) of forty-three cases were associated with no sequelae (such as pain, loss of function, or decreased sensation). The two patients who lost function had fasciotomy 82.5 and eighty-six hours after the injury.
CONCLUSIONS
Despite a long period from injury to fasciotomy, most children who are managed for acute traumatic compartment syndrome of the leg have an excellent outcome. This delay may occur because acute traumatic compartment syndrome manifests itself more slowly in children or because the diagnosis is harder to establish in this age group. The results of the present study should raise awareness of late presentation and the importance of vigilance for developing compartment syndrome in the early days after injury. Fasciotomy during the acute swelling phase, even long after injury, produced excellent results with no cases of infection.
背景
目前，儿童最常见的创伤性间隔综合征临床情况是小腿急性创伤性间隔综合征。我们研究了儿童小腿急性创伤性间隔综合征的病因、诊断、治疗和结果。
方法
在十七年期间，我们从两个大型儿科创伤中心收集了 42 名骨骼未成熟患者的 43 例小腿急性创伤性间隔综合征病例。所有患有急性创伤性间隔综合征的儿童均接受了筋膜切开术。记录了损伤的机制、损伤的日期和时间、诊断的时间、间隔压力、筋膜切开术的时间以及最后一次随访时的结果。
结果
42 名患者中的 35 名（83％）因机动车事故受伤，同时伴有胫骨和腓骨骨折。从受伤到筋膜切开术的平均时间为 20.5 小时（范围为 3.9 至 118 小时）。通常，在最后一次随访时，功能结果极好。当筋膜切开术在受伤后很长时间进行时，没有发现感染的病例。在最后一次随访时，43 例中的 41 例（95％）没有后遗症（如疼痛、功能丧失或感觉减退）。2 例失去功能的患者的筋膜切开术分别在受伤后 82.5 小时和 86 小时进行。
结论
尽管从受伤到筋膜切开术的时间很长，但大多数接受急性创伤性间隔综合征治疗的儿童都有极好的结果。这种延迟可能是由于儿童的急性创伤性间隔综合征表现得更慢，或者由于在这个年龄段更难确定诊断。本研究的结果应引起人们对发病后期的表现以及受伤后早期警惕性的认识，从而提高对发展性间隔综合征的认识。在急性肿胀期进行筋膜切开术，即使在受伤后很长时间进行，也能产生极好的结果，而且没有感染的病例。
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