Livingston Kristin S, Glotzbecker Michael P, Shore Benjamin J
From the Department of Orthopaedic Surgery, University of California San Francisco School of Medicine, San Francisco, CA (Dr. Livingston) and the Department of Orthopaedic Surgery, Harvard Medical School, Boston Children's Hospital, Boston, MA (Dr. Glotzbecker and Dr. Shore).
J Am Acad Orthop Surg. 2017 May;25(5):358-364. doi: 10.5435/JAAOS-D-15-00655.
Pediatric acute compartment syndrome (PACS) is a clinical entity that must be carefully differentiated from the adult version (ie, acute compartment syndrome). Healthcare providers must understand the variable etiologies of PACS, of which trauma is the most common but can also include vascular insult, infection, surgical positioning, neonatal phenomena, overexertion, and snake and insect bites. In addition to the unique etiologies of PACS, providers must also recognize the different signs and symptoms of PACS. The three As (ie, anxiety, agitation, analgesic requirement) of PACS have supplanted the classic adult signs as being more accurate and allowing earlier detection. In children with questionable clinical signs but concern for PACS, compartment pressure measurement may be necessary to confirm the diagnosis. Overall, outcomes after fasciotomy in children tend to be excellent; however, diagnostic delays secondary to unfamiliar clinical scenarios can lead to myonecrosis and subsequent poor outcomes.
小儿急性骨筋膜室综合征（PACS）是一种必须与成人型（即急性骨筋膜室综合征）仔细区分的临床病症。医疗服务提供者必须了解PACS的多种病因，其中创伤最为常见，但也可能包括血管损伤、感染、手术体位、新生儿现象、过度劳累以及蛇虫叮咬。除了PACS独特的病因外，医疗服务提供者还必须认识到PACS不同的体征和症状。PACS的三个A（即焦虑、烦躁、镇痛需求）已取代了成人的经典体征，因为它们更准确且能更早发现病情。对于临床体征存疑但怀疑患有PACS的儿童，可能需要测量骨筋膜室内压力以确诊。总体而言，儿童行筋膜切开术后的预后往往良好；然而，因不熟悉临床情况导致的诊断延迟可能会引发肌肉坏死并继而导致不良后果。
