Oak Nikhil R, Abrams Reid A
Department of Orthopaedic Surgery, University of California, San Diego, 200 West Arbor Drive, #8670, San Diego, CA 92103-8670, USA.
Hand, Upper Extremity, and Microvascular Surgery, Department of Orthopaedic Surgery, University of California, San Diego, 200 West Arbor Drive, #8670, San Diego, CA 92103-8670, USA.
Orthop Clin North Am. 2016 Jul;47(3):609-16. doi: 10.1016/j.ocl.2016.03.006.
Hand compartment syndrome has many etiologies; untreated, it has dire functional consequences. Intracompartmental pressure exceeding capillary filling pressure causes decreased tissue perfusion resulting in progressive ischemic death of compartment contents. Clinical findings can evolve. Serial physical examinations are recommended and, if equivocal, interstitial pressure monitoring is indicated. Definitive management is emergent fasciotomies with incisions designed to decompress the involved hand compartments, which could include the thenar, hypothenar, and interosseous compartments, and the carpal tunnel. Careful wound care, edema management, splinting, and hand therapy are critical. Therapy should start early postoperatively, possibly before wound closure.
手部骨筋膜室综合征有多种病因;若不治疗,会产生严重的功能后果。骨筋膜室内压力超过毛细血管充盈压会导致组织灌注减少,进而造成骨筋膜室内内容物进行性缺血性坏死。临床症状会逐渐发展。建议进行系列体格检查,若诊断不明确,则需进行组织间压力监测。确切的治疗方法是紧急行筋膜切开术,切口设计用于减压受累的手部骨筋膜室,可能包括大鱼际、小鱼际、骨间肌室和腕管。仔细的伤口护理、水肿管理、夹板固定和手部治疗至关重要。治疗应在术后早期开始,甚至可能在伤口闭合前就开始。