Tharakan Sasha J, Subotic Ulrike, Kalisch Markus, Staubli Georg, Weber Daniel M
*Pediatric Hand Surgery, University Children's Hospital Zurich †Seminar for Statistics, ETH Zurich ‡Department of Emergency Medicine, University Children's Hospital Zurich, Zurich, Switzerland.
J Pediatr Orthop. 2016 Jun;36(4):410-5. doi: 10.1097/BPO.0000000000000471.
Acute compartment syndrome (ACS) can lead to irreversible damage if fasciotomy is not performed in a timely manner. Needle manometry is a tool to confirm suspected ACS. The threshold for compartment pressures that can be tolerated has been debated. The aim of this study is to assess the normal compartment pressures in noninjured forearms of children. Further, we sought to quantify the maximum tolerable compartment pressures in fractured forearms of children, thus establishing a baseline and providing guidance in evidence-based decision making to evaluate children with suspected ACS.
This prospective study included children up to the age of 16 years with forearm fractures that needed reduction with or without osteosynthesis. Between June 2009 and March 2013, 41 children were included. Mean age was 9.25 years (range, 4 to 15.4 y). We used needle manometry to measure the pressures in the superficial and deep volar as well as in the dorsal compartments (DCs) on both the forearms. The mean pressures between compartments in healthy versus injured arms were analyzed using a 1-sided, paired t test.
On the injured side, the mean compartment pressure was 19.12 mm Hg (range, 3 to 49 mm Hg) in the deep volar compartment, 15.56 mm Hg (range, 5 to 37 mmHg) in the DC, and 14.8 mm Hg (range, 2 to 35 mm Hg) in the superficial volar compartment. On the noninjured side, the mean compartment pressure was 12.9 mm Hg (range, 6 to 31 mm Hg) in the DC, 10.22 mm Hg (range, 3 to 22 mm Hg) in the deep volar compartment, and 9.66 mm Hg (range, 3 to 21 mm Hg) in the superficial volar compartment. We measured an absolute compartment pressure of >30 mm Hg in 15 patients on the fractured side. Three of them had an absolute compartment pressure of >45 mm Hg. Only 1 had ACS. This patient underwent fasciotomy and was excluded for further analysis. On follow-up (mean, 24.84 mo), no patient was found to have any sequelae of ACS.
This is the first study to report normal compartment pressure measurements in noninjured forearms and in fractured forearms without clinical suspicion of ACS in children.The mean compartment pressure measured in the deep volar compartment (DVC) in healthy children was 10.22 mm Hg (range, 3 to 22 mm Hg) and therefore slightly higher than in adults. Some children with fractures tolerated absolute compartment pressures >30 mm Hg without clinical signs of ACS. Fasciotomy in children under close observation could eventually be delayed despite surpassing the accepted pressure limits for adults.
Level I-prognostic.
如果不及时进行筋膜切开术，急性骨筋膜室综合征（ACS）可导致不可逆转的损伤。针式测压法是一种用于确诊疑似ACS的工具。可耐受的骨筋膜室内压力阈值一直存在争议。本研究的目的是评估儿童未受伤前臂的正常骨筋膜室内压力。此外，我们试图量化儿童前臂骨折时可耐受的最大骨筋膜室内压力，从而建立一个基线，并为评估疑似ACS的儿童提供循证决策指导。
这项前瞻性研究纳入了16岁及以下需要进行或不需要进行骨固定术复位的前臂骨折儿童。在2009年6月至2013年3月期间，共纳入41名儿童。平均年龄为9.25岁（范围为4至15.4岁）。我们使用针式测压法测量双侧前臂浅掌侧、深掌侧以及背侧骨筋膜室（DC）的压力。使用单侧配对t检验分析健康手臂与受伤手臂各骨筋膜室之间的平均压力。
在受伤侧，深掌侧骨筋膜室的平均骨筋膜室内压力为19.12 mmHg（范围为3至49 mmHg），DC为15.56 mmHg（范围为5至37 mmHg），浅掌侧骨筋膜室为14.8 mmHg（范围为2至35 mmHg）。在未受伤侧，DC的平均骨筋膜室内压力为12.9 mmHg（范围为6至31 mmHg），深掌侧骨筋膜室为10.22 mmHg（范围为3至22 mmHg），浅掌侧骨筋膜室为9.66 mmHg（范围为3至21 mmHg）。我们在骨折侧的15名患者中测量到绝对骨筋膜室内压力>30 mmHg。其中3人的绝对骨筋膜室内压力>45 mmHg。只有1人患有ACS。该患者接受了筋膜切开术并被排除在进一步分析之外。在随访（平均24.84个月）时，未发现任何患者有ACS的后遗症。
这是第一项报告儿童未受伤前臂以及无临床疑似ACS的骨折前臂正常骨筋膜室内压力测量结果的研究。健康儿童深掌侧骨筋膜室（DVC）测量的平均骨筋膜室内压力为10.22 mmHg（范围为3至22 mmHg），因此略高于成人。一些骨折儿童可耐受绝对骨筋膜室内压力>30 mmHg且无ACS的临床体征。尽管超过了成人公认的压力限值，但在密切观察下，儿童的筋膜切开术最终可能会延迟。
I级-预后性。
Zotero 插件