Gordon Wade T, Talbot Max, Shero John C, Osier Charles J, Johnson Anthony E, Balsamo Luke H, Stockinger Zsolt T
Joint Trauma System, 3698 Chambers Pass, Joint Base San Antonio, Fort Sam Houston, TX.
Mil Med. 2018 Sep 1;183(suppl_2):108-111. doi: 10.1093/milmed/usy084.
Acute compartment syndrome (CS) is a frequent and potentially devastating complication of blunt and penetrating extremity injuries. Extremity war injuries are particularly susceptible to CS due to associated vascular injuries; high Injury Severity Score; extensive bone and soft tissue injury; and frequent transportation that may limit close monitoring of the injured extremity. Treatment consists of prompt fasciotomy of all compartments in the involved segment, over their full length. Delayed or incomplete fasciotomy is associated with worse outcomes, including muscle necrosis, infection, and amputation. Enhanced pre-deployment training of surgeons decreases the need for revision fasciotomy at higher echelons of care and should be continued in future conflicts. We recommend the liberal use of prophylactic fasciotomy prior to aeromedical evacuation and after limb reperfusion. For leg fasciotomy, we recommend a two-incision approach as it is more reproducible and allows easy vascular exposure when necessary.
急性骨筋膜室综合征（CS）是钝性和穿透性肢体损伤常见且可能造成严重后果的并发症。由于伴有血管损伤、损伤严重程度评分高、广泛的骨骼和软组织损伤以及频繁转运可能限制对受伤肢体的密切监测，肢体战伤尤其易发生CS。治疗包括对受累节段的所有骨筋膜室进行全长的及时切开减压。延迟或不完全切开减压与更差的预后相关，包括肌肉坏死感染和截肢。加强外科医生的部署前培训可减少在更高层级治疗中进行再次切开减压的需求，并且在未来冲突中应继续开展。我们建议在航空医疗后送前和肢体再灌注后广泛使用预防性切开减压。对于小腿切开减压，我们建议采用双切口方法，因为它更具可重复性，并且在必要时便于暴露血管。
