Via Alessio Giai, Oliva Francesco, Spoliti Marco, Maffulli Nicola
Department of Orthopaedic and Traumatology, University of Rome "Tor Vergata", School of Medicine, Rome, Italy.
Department of Orthopaedics and Traumatology, San Camillo-Forlanini Hospital, Rome, Italy.
Muscles Ligaments Tendons J. 2015 Mar 27;5(1):18-22. eCollection 2015 Jan-Mar.
acute compartment syndrome (ACS) is one of the few true emergencies in orthopedics and traumatology. It is a painful condition caused by the increase interstitial pressure (intracompart-mental pressure - ICP) within a closed osteofascial compartment which impair local circulation. It occurs most often in the legs, but it can affects also the arms, hands, feet, and buttocks. It usually develops after a severe injury such as fractures or crush injury, but it can also occurs after a relatively minor injury and it may be iatrogenic. Uncommon causes of ACS have been also described, that suggest surgeons to pay great attention to this serious complication. Diagnosing ACS is difficult in clinical practice, even among expert surgeons. Currently, the diagnosis is made on the basis of physical examination and repeated ICP measures. ICP higher than 30 mmHg of diastolic blood pressure is significant of compartment syndrome. Once diagnosis is made, fasciotomy to release the affected compartment should be performed as early as possible because delayed decompression would lead to irreversible ischemic damage to muscles and peripheral nerves.
acute compartment syndrome is a surgical emergency. There is still little consensus among authors about diagnosis and treatment of these serious condition, in particular about the ICP at which fasciotomy is absolutely indicated and the timing of wound closure. New investigations are needed in order to improve diagnosis and treatment of ACS.
急性骨筋膜室综合征（ACS）是骨科和创伤学领域为数不多的真正紧急情况之一。它是一种由封闭的骨筋膜室内间质压力（骨筋膜室内压力 - ICP）升高引起的疼痛性病症，会损害局部血液循环。它最常发生在腿部，但也可影响手臂、手部、足部和臀部。它通常在严重损伤如骨折或挤压伤后发生，但也可能在相对较小的损伤后出现，并且可能是医源性的。还描述了ACS的罕见病因，这提示外科医生要高度重视这种严重并发症。在临床实践中，即使是专家外科医生，诊断ACS也很困难。目前，诊断基于体格检查和反复测量ICP。ICP高于舒张压30 mmHg提示骨筋膜室综合征。一旦确诊，应尽早进行筋膜切开术以松解受影响的骨筋膜室，因为延迟减压会导致肌肉和周围神经不可逆转的缺血性损伤。
急性骨筋膜室综合征是一种外科急症。作者们对于这种严重病症的诊断和治疗，特别是关于绝对需要进行筋膜切开术的ICP以及伤口闭合的时机，仍存在很少的共识。需要进行新的研究以改善ACS的诊断和治疗。
