Tischenko G J, Goodman S B
Division of Orthopaedic Surgery, Stanford University Medical Center, California 94305-5326.
J Bone Joint Surg Am. 1990 Jan;72(1):41-4.
Three patients had compartment syndrome of the leg after tibial intramedullary nailing with reaming. They were all treated successfully with emergency fasciotomy. A prospective study was done of seven additional patients who had continual monitoring of the pressure in the deep posterior compartment during tibial intramedullary nailing with reaming. In five of them, the procedure was performed three weeks or less after injury and in the remaining two, the nailing was performed later for the treatment of non-union. Two pressure peaks in the deep posterior compartment were noted: one after strong longitudinal traction was applied and the fracture was reduced and the other during intramedullary reaming. Intraoperative pressure of thirty millimeters of mercury or more were recorded in three of the seven patients. In the treatment of tibial fractures, operative procedures that involve forceful traction for a long time may predispose the patient to compartment syndrome in the leg. Close clinical observation of such patients is needed. When there is a high risk of compartment syndrome, monitoring of the pressure in the compartment may be prudent.
3例患者在扩髓胫骨髓内钉固定术后出现小腿骨筋膜室综合征。他们均通过急诊筋膜切开术成功治愈。对另外7例在扩髓胫骨髓内钉固定术中持续监测深后侧骨筋膜室压力的患者进行了一项前瞻性研究。其中5例在受伤后3周或更短时间内进行了手术，其余2例则在后期进行了手术以治疗骨不连。观察到深后侧骨筋膜室出现两个压力峰值：一个在施加强力纵向牵引使骨折复位后出现，另一个在髓内扩髓时出现。7例患者中有3例术中记录到30毫米汞柱或更高的压力。在治疗胫骨骨折时，长时间进行强力牵引的手术操作可能使患者易发生小腿骨筋膜室综合征。需要对这类患者进行密切的临床观察。当骨筋膜室综合征风险较高时，对骨筋膜室内压力进行监测可能是谨慎的做法。
