Bodansky D, Doorgakant A, Alsousou J, Iqbal H J, Fischer B, Scicluna G, Bowers M, Narayan B
Royal Liverpool University Hospital, United Kingdom.
Royal Liverpool University Hospital, United Kingdom.
Injury. 2018 Sep;49(9):1699-1702. doi: 10.1016/j.injury.2018.04.020. Epub 2018 Apr 20.
The best outcomes following Acute Compartment Syndrome (ACS) are attributed to early diagnosis and treatment. National guidelines were issued in the United Kingdom in 2014 (BOAST 10) to standardise and improve management. We analysed standards of diagnosis and management before and after the introduction of the guidelines.
We retrospectively reviewed the data of all patients with ACS requiring fasciotomy between March 2010 and May 2015 across four Major Trauma Centres (MTCs) in the Northwest of England. We analysed the pooled data for variations between the centres and the effect of BOAST10 implementation.
75 fasciotomies were recorded, with trauma being the cause in 42 cases (56%). The commonest site was the leg (44, 59%) followed by the forearm (15, 20%). The median time from decision to operate to fasciotomy was 2 h (range 0-6) and thereafter a median of 2 days (1-7) until a second visit. The practice across the four centres was similar up to diagnosis and treatment, but there was significant variation in practice after fasciotomy. The BOAST guidelines did not improve the time to surgery, time to second visit nor the recording of clinical signs. 21 patients had severe complications, including one death and 4 amputations.
There continues to be significant variability in the definitive management of ACS. National guidelines do not appear to make a discernible impact on practice, and additional methods of ensuring safe management of this critical condition seem warranted.
急性骨筋膜室综合征（ACS）的最佳治疗效果归因于早期诊断和治疗。英国于2014年发布了国家指南（BOAST 10），以规范和改进管理。我们分析了指南引入前后的诊断和管理标准。
我们回顾性分析了2010年3月至2015年5月期间，英格兰西北部四个主要创伤中心（MTCs）所有需要进行筋膜切开术的ACS患者的数据。我们分析了汇总数据，以了解各中心之间的差异以及BOAST10实施的效果。
记录了75例筋膜切开术，其中42例（56%）的病因是创伤。最常见的部位是腿部（44例，59%），其次是前臂（15例，20%）。从决定手术到进行筋膜切开术的中位时间为2小时（范围0 - 6小时），此后直到第二次就诊的中位时间为2天（1 - 7天）。四个中心在诊断和治疗之前的做法相似，但在筋膜切开术后的做法存在显著差异。BOAST指南并未缩短手术时间、第二次就诊时间，也未改善临床体征的记录。21例患者出现严重并发症，包括1例死亡和4例截肢。
ACS的确定性治疗仍存在显著差异。国家指南似乎并未对实际操作产生明显影响，因此有必要采取其他方法来确保对这种危急情况进行安全管理。
