Lim K B L, Laine T, Chooi J Y, Lye W K, Lee B J Y, Narayanan U G
Department of Orthopaedic Surgery & Division of Surgery, KK Women's & Children's Hospital, Singapore, Singapore.
Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg, Sweden.
J Child Orthop. 2018 Oct 1;12(5):480-487. doi: 10.1302/1863-2548.12.180049.
Acute compartment syndrome (ACS) requires urgent fasciotomy to decompress the relevant muscle compartment/s prior to onset of irreversible myonecrosis and nerve injury. A fasciotomy is not a benign procedure. This study aims to describe and quantify early morbidity directly associated with fasciotomies for ACS in children.
Clinical charts of 104 children who underwent 112 fasciotomies over a 13-year period at a tertiary children's hospital were reviewed. The following were analyzed: ACS aetiology, fasciotomy site, number of subsequent procedures, method of wound closure, short-term complications and length of hospital stay.
Short-term complications included wound infections (6.7%) and the need for blood transfusion (7.7%). Median number of additional operations for wound closure was two (0 to 10) and median inpatient stay was 12 days (3 to 63; SD 11.7). After three unsuccessful attempts at primary closure, likelihood of needing skin grafting for coverage exceeded 80%. Analyses showed that fasciotomy-wound infections were associated with higher risk for four or more closure procedures. Number of procedures required for wound closure correlated with longer inpatient stay as did ACS associated with non-orthopaedic causes.
Fasciotomy is associated with significant early morbidity, the need for multiple closure operations, and prolonged hospital stay. The decision for fasciotomy needs careful consideration to avoid unnecessary fasciotomies, without increasing the risk of permanent injury from missed or delayed diagnosis. Skin grafting should be considered after three unsuccessful closure attempts. Less invasive tests or continuous monitoring (for high-risk patients) for compartment syndrome may help reduce unnecessary fasciotomies.
Level IV, Case series.
急性骨筋膜室综合征（ACS）需要紧急进行筋膜切开术，以在不可逆性肌肉坏死和神经损伤发生之前对相关肌肉筋膜室进行减压。筋膜切开术并非无害的手术。本研究旨在描述和量化与儿童ACS筋膜切开术直接相关的早期发病率。
回顾了一家三级儿童医院在13年期间104例接受112次筋膜切开术的儿童的临床病历。分析了以下内容：ACS病因、筋膜切开部位、后续手术次数、伤口闭合方法、短期并发症和住院时间。
短期并发症包括伤口感染（6.7%）和输血需求（7.7%）。伤口闭合的额外手术中位数为两次（0至10次），住院中位数为12天（3至63天；标准差11.7）。在初次闭合尝试三次失败后，需要植皮覆盖的可能性超过80%。分析表明，筋膜切开伤口感染与四次或更多次闭合手术的较高风险相关。伤口闭合所需的手术次数与住院时间延长相关，与非骨科原因相关的ACS也是如此。
筋膜切开术与显著的早期发病率、多次闭合手术需求和住院时间延长相关。筋膜切开术的决策需要仔细考虑，以避免不必要的筋膜切开术，同时不增加漏诊或延迟诊断导致永久性损伤的风险。在三次闭合尝试失败后应考虑植皮。对于骨筋膜室综合征，侵入性较小的检查或持续监测（针对高危患者）可能有助于减少不必要的筋膜切开术。
IV级，病例系列。
