Kenny Ryan M, Beiser Christopher W, Patel Arun
Department of Orthopedics, Mercy St. Vincent Medical Center, Toledo, OH, USA.
Int J Shoulder Surg. 2013 Jan;7(1):28-31. doi: 10.4103/0973-6042.109891.
Acute compartment syndrome occurs when pressure within a confined fascial space rises to a level impairing microvascular perfusion to surrounding tissues.[1234567] The majority of the reported literature is based on lower extremity compartment syndrome, but any muscle group within an osteofascial compartment has the potential to develop compartment syndrome. We report a case of a 64-year-old male who developed an acute compartment syndrome of both the supraspinatus and infraspinatus after sustaining a severely comminuted scapula fracture. Diagnosis of compartment syndrome was made after intracompartmental pressure measurements of the supraspinatus and infraspinatus revealed pressures within 30 mmHg of the diastolic blood pressure, prompting emergency decompressive fasciotomy. At final follow-up, the examination revealed full shoulder strength with near-full range of motion. There were no signs of sequelae from compartment syndrome at any point. Few case reports describe compartment syndrome of the periscapular fascial compartments. However, these cases were either retrospectively diagnosed[89] or diagnosed via magnetic resonance imaging (MRI) findings and lab values.[910] Surgical management of acute compartment syndrome of the supraspinatus has been reported in only one other case.[10] To our knowledge, we report the only case of a patient with acute compartment syndrome of both the supraspinatus and infraspinatus compartments treated with emergent decompressive fasciotomy. Due to the devastating complications and functional loss of a missed diagnosis of compartment syndrome, a high index of clinical suspicion for developing compartment syndrome must be maintained in every fracture setting, regardless of anatomic location or rarity of reported cases.
当密闭筋膜间隙内的压力升高到损害周围组织微血管灌注的水平时，就会发生急性筋膜室综合征。[1234567] 大多数已发表的文献基于下肢筋膜室综合征，但骨筋膜室内的任何肌肉群都有可能发生筋膜室综合征。我们报告一例64岁男性，在遭受严重粉碎性肩胛骨骨折后，发生了冈上肌和冈下肌的急性筋膜室综合征。在对冈上肌和冈下肌进行筋膜室内压力测量，显示压力在舒张压的30 mmHg以内后，做出了筋膜室综合征的诊断，随即进行了紧急减压筋膜切开术。在最后一次随访时，检查显示肩部力量完全恢复，活动范围几乎完全正常。在任何时候都没有筋膜室综合征后遗症的迹象。很少有病例报告描述肩胛周筋膜室的筋膜室综合征。然而，这些病例要么是回顾性诊断的[89]，要么是通过磁共振成像（MRI）结果和实验室检查值诊断的。[910] 仅在另一例中报道了冈上肌急性筋膜室综合征的手术治疗。[10] 据我们所知，我们报告了唯一一例同时患有冈上肌和冈下肌急性筋膜室综合征并接受紧急减压筋膜切开术治疗的患者。由于筋膜室综合征漏诊会导致严重并发症和功能丧失，因此在每一例骨折情况下，无论解剖位置如何或报道病例的罕见程度如何，都必须保持对发生筋膜室综合征的高度临床怀疑。
