Lollo Loreto, Grabinsky Andreas
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA.
Int J Crit Illn Inj Sci. 2016 Jul-Sep;6(3):133-142. doi: 10.4103/2229-5151.190648.
Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy.
Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted.
One hundred twenty-four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty-one percent were male. Motorized vehicles caused 51% of injuries in males. Forty-one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty-seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery. At long-term follow-up, 10.2% of patients reported moderate lower extremity pain and 69.2% had returned to work.
Escalation in leg pain and changes in sensation are the cardinal signs for CS rather than reliance on assessing for firm compartments and pressures. The severity of nerve injury worsens with the delay in performing fasciotomy. Standardized diagnostic protocols and wound treatment strategies will result in improved outcomes from this complication.
急性下肢骨筋膜室综合征（CS）若不治疗会导致不可逆的神经和肌肉缺血。及时进行减压筋膜切开术可预防永久性残疾。在情况不明时使用骨筋膜室内压力（iCP）测量有助于诊断严重的腿痛。作为下肢创伤的一种罕见并发症，CS的后果包括慢性疼痛、神经损伤和挛缩。本研究的目的是观察筋膜切开术后下肢CS患者的临床和功能结局。
对出院诊断为CS的患者进行回顾性病历分析。收集患者的身体特征、就业状况、受伤时的活动情况、损伤严重程度评分、骨折类型、疼痛评分、至筋膜切开术的时间、iCP、血清肌酸激酶水平、伤口治疗方案、住院时间和出院机构等信息。记录出院后30天和12个月时的下肢神经学检查、疼痛评分、骨科并发症和就业状况。
本研究共纳入124例患者。108例患者在12个月时接受了评估。81%为男性。机动车导致男性51%的损伤。41%的损伤为胫骨骨折。急性肾损伤发生率为2.4%。血清肌酸激酶平均峰值水平为58,600单位/毫升。78.9%的非骨折患者使用纱布敷料，78.2%的骨折患者使用负压伤口真空疗法。约21.6%的CS患者曾接受过手术。近12.9%的患者需要截肢。截肢患者中约81.8%为男性。67%的截肢患者伴有血管损伤。20.5%的患者出现足部麻木，18.2%的患者出现垂足性麻痹。10.2%的患者发生骨髓炎，6.8%的患者发生骨折不愈合。约14.7%的患者接受了进一步的骨科手术。在长期随访中，10.2%的患者报告有中度下肢疼痛，69.2%的患者已恢复工作。
腿痛加剧和感觉改变是CS的主要体征，而非依赖于评估坚硬的骨筋膜室和压力。筋膜切开术延迟会使神经损伤的严重程度加重。标准化的诊断方案和伤口治疗策略将改善这一并发症的结局。
