Duan Xin, Zhang Kaiwei, Zhong Gang, Cen Shiqiang, Huang Fuguo, Lv Jingtong, Xiang Zhou
Department of Orthopedics, West China Hospital, Sichuan University, Sichuan, China.
Orthopedics. 2012 Apr;35(4):e486-90. doi: 10.3928/01477447-20120327-17.
Compartment syndrome of the thigh is a rare emergency often treated operatively. The purpose of this study was to evaluate the effects of nonoperative treatment for compartment syndrome of the thigh associated with acute renal failure after the 2008 Wenchuan earthquake. Nonoperative treatment, which primarily involves continuous renal replacement therapy, was performed in 6 patients (3 men and 3 women) who presented with compartment syndrome of the thigh associated with acute renal failure. The mean mangled extremity severity score (MESS) and laboratory data regarding renal function were analyzed before and after treatment, and the clinical outcome was evaluated at 17-month follow-up. Laboratory data regarding renal function showed improvements. All 6 patients survived with the affected lower limbs intact after nonoperative treatment. Follow-up revealed active knee range of motion and increased muscle strength, as well as a recovery of sensation. A positive linear correlation was found between MESS and the time required to achieve a reduction in swelling, as well as the time required for the recovery of sensation and knee range of motion (r>0.8; P<.05). Satisfactory clinical outcomes were obtained in patients with compartment syndrome of the thigh associated with acute renal failure.Urine alkalization, electrolyte and water balance, and continuous renal replacement therapy have played an important role in saving lives and extremities. Nonoperative treatment should be considered in the treatment of compartment syndrome of the thigh associated with acute renal failure.
大腿骨筋膜室综合征是一种罕见的急症，常需手术治疗。本研究的目的是评估2008年汶川地震后非手术治疗对合并急性肾衰竭的大腿骨筋膜室综合征的效果。对6例（3男3女）合并急性肾衰竭的大腿骨筋膜室综合征患者进行了以持续肾脏替代治疗为主的非手术治疗。分析了治疗前后的平均肢体毁损严重程度评分（MESS）及肾功能实验室数据，并在17个月的随访时评估临床结局。肾功能实验室数据显示有所改善。6例患者经非手术治疗后均存活，患侧下肢完好。随访发现膝关节活动范围正常、肌肉力量增强以及感觉恢复。MESS与肿胀减轻所需时间、感觉恢复及膝关节活动范围恢复所需时间呈正线性相关（r>0.8；P<0.05）。合并急性肾衰竭的大腿骨筋膜室综合征患者获得了满意的临床结局。尿液碱化、电解质及水平衡以及持续肾脏替代治疗在挽救生命和肢体方面发挥了重要作用。对于合并急性肾衰竭的大腿骨筋膜室综合征的治疗应考虑非手术治疗。
