Lawrence John E, Cundall-Curry Duncan J, Stohr Kuldeep K
Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
Case Rep Orthop. 2016;2016:9127070. doi: 10.1155/2016/9127070. Epub 2016 Mar 17.
A male patient in his fifties presented to his local hospital with numbness and weakness of the right leg which left him unable to mobilise. He reported injecting heroin the previous morning. Following an initial diagnosis of acute limb ischaemia the patient was transferred to a tertiary centre where Computed Tomography Angiography was reported as normal. Detailed neurological examination revealed weakness in hip flexion and extension (1/5 on the Medical Research Council scale) with complete paralysis of muscle groups distal to this. Sensation to pinprick and light touch was globally reduced. Blood tests revealed acute kidney injury with raised creatinine kinase and the patient was treated for rhabdomyolysis. Orthopaedic referral was made the following day and a diagnosis of gluteal compartment syndrome (GCS) was made. Emergency fasciotomy was performed 56 hours after the onset of symptoms. There was immediate neurological improvement following decompression and the patient was rehabilitated with complete nerve recovery and function at eight-week follow-up. This is the first documented case of full functional recovery following a delayed presentation of GCS with sciatic nerve palsy. We discuss the arguments for and against fasciotomy in cases of compartment syndrome with significant delay in presentation or diagnosis.
一名五十多岁的男性患者因右腿麻木和无力前往当地医院就诊，导致无法活动。他报告前一天上午注射了海洛因。初步诊断为急性肢体缺血后，该患者被转至一家三级医疗中心，计算机断层血管造影显示正常。详细的神经系统检查发现髋关节屈伸无力（医学研究委员会肌力分级为1/5级），其远端肌肉群完全瘫痪。针刺觉和轻触觉整体减退。血液检查显示急性肾损伤，肌酸激酶升高，患者接受了横纹肌溶解症的治疗。第二天进行了骨科会诊，诊断为臀肌间室综合征（GCS）。症状出现56小时后进行了紧急筋膜切开术。减压后神经功能立即改善，患者在八周随访时完全神经恢复且功能康复。这是第一例记录在案的GCS伴坐骨神经麻痹延迟就诊后完全功能恢复的病例。我们讨论了在间室综合征出现明显延迟就诊或诊断的情况下进行筋膜切开术的支持和反对理由。
