Breda R, Bazile F, Bauer B
Service de chirurgie orthopédique et traumatologique, HIA Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
Chir Main. 2012 Jun;31(3):113-7. doi: 10.1016/j.main.2012.04.006. Epub 2012 May 9.
Crush injuries of the hand have a bad prognosis. The development of a compartment syndrome in crush injuries is feared but rare, and usually affects the radial interosseous muscle compartment due to certain anatomic features. The usual clinical presentation is an edematous hand held in a slightly intrinsic position with severe pain resistant to level 111 analgesia. Passive extension of the digits increases the pain. Diagnosis is confirmed by measuring compartmental pressure in all compartments so as not to miss a case. The aim of this work is to resolve differences in compartmental pressure measurements that may cause misdiagnosis and surgical error. The dermofasciectomy is the only treatment that stops muscle ischemia and avoids perpetuation of the viscious circle of irreversible damage. Functional prognosis is compromised in compartment syndrome and the dermofasciectomy cannot be delayed under any circumstance.
手部挤压伤预后不佳。挤压伤中骨筋膜室综合征的发生令人担忧但较为罕见,由于某些解剖学特征,通常影响桡侧骨间肌骨筋膜室。常见的临床表现是手部肿胀,处于轻度内在肌挛缩位,疼痛剧烈,三级镇痛难以缓解。手指被动伸展时疼痛加剧。通过测量所有骨筋膜室的压力来确诊,以免漏诊。这项研究的目的是解决可能导致误诊和手术失误的骨筋膜室压力测量差异问题。皮肤筋膜切除术是唯一能阻止肌肉缺血并避免不可逆损伤恶性循环持续的治疗方法。骨筋膜室综合征会影响功能预后,在任何情况下都不能延迟进行皮肤筋膜切除术。