足部急性骨筋膜室综合征模型中背侧皮肤筋膜开窗与筋膜切开术的比较。

Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot.

机构信息

1 University of Wisconsin, Department of Orthopedics and Rehabilitation, Madison, WI, USA.

2 University of Wisconsin-Madison, Department of Biostatistics and Medical Informatics, Madison, WI, USA.

出版信息

Foot Ankle Int. 2019 Jul;40(7):853-858. doi: 10.1177/1071100719839944. Epub 2019 Apr 1.

DOI:10.1177/1071100719839944

PMID:30929469

Abstract

BACKGROUND

Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression.

METHODS

Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies.

RESULTS

Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( < .005).

CONCLUSION

Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments.

CLINICAL RELEVANCE

The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.

摘要

背景

由于存在感染和软组织覆盖问题的理论风险，足部筋膜切开术治疗骨筋膜室综合征仍然存在争议。本研究的目的是评估背侧皮肤筋膜开窗与筋膜切开术在尸体足部骨筋膜室综合征模型中的疗效。我们假设筋膜切开术和背侧皮肤筋膜开窗术可以提供等效的骨筋膜室减压。

方法

在 10 个新鲜冷冻的尸体四肢的第一骨间背侧（FDIO）、外展（ABD）和足底浅层（SP）间隙中监测间隙内压力。创建了一个骨筋膜室综合征模型。在进行背侧皮肤筋膜开窗和正式筋膜切开后获得压力测量值。主要观察变量是 FDIO、ABD 和 SP 间隙的间隙内压力，共 4 种特定情况：（1）基线压力，（2）骨筋膜室综合征后压力，（3）皮肤筋膜开窗后压力，（4）筋膜切开后压力。