Guo Jialiang, Yin Yingchao, Jin Lin, Zhang Ruipeng, Hou Zhiyong, Zhang Yingze
Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University.
Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang.
Medicine (Baltimore). 2019 Jul;98(27):e16260. doi: 10.1097/MD.0000000000016260.
Acute compartment syndrome (ACS) is defined as a clinical entity originated from trauma or other conditions, and remains challenging to diagnose and treat effectively. The review was aim to present the controversy in diagnosing, treating ACS. It was found that there was no criterion about the ACS, and result unnecessary osteotomy. The presence of clinical assessment (5P) always means the necrosis of muscles and was the most serious or irreversible stage of ACS. Besides pressure methods, the threshold of pressure identifying ACS was also controversial.
Immediate surgical fasciotomy was important to prevent severe suquelae of the ACS. However, there was still controversy about the right time that fasciotomy should be done to avoid irreversible ischemic changes. The most important thing to treat ACS was comprehension to the true injury mechanism, but a systemic classification about traumatic mechanism in most literature was not clear.
After observations to fracture patients with blister, we recommended that surgeons dealing with such emergencies should be vigilant, and the indication for fasciotomy should be strictly controlled following with injury mechanism especially for patients without severe soft tissue injury.
For those crushing and soft tissue injuries, the current evidence based strategies for managing patients was useful, but for those fracture related injury, more examination was necessary to avoid overtreatment especially for those patients with blister observed. In facing patients, medical history, injured mechanism should be paid special attention, and rigorous classification about traumatic etiology was the key for the treatment of these patients.
急性骨筋膜室综合征（ACS）被定义为一种源于创伤或其他情况的临床病症，其有效诊断和治疗仍具有挑战性。本综述旨在阐述ACS诊断和治疗方面的争议。发现对于ACS尚无标准，且会导致不必要的截骨术。临床评估（5P）的出现总是意味着肌肉坏死，且是ACS最严重或不可逆的阶段。除了压力测量方法外，确定ACS的压力阈值也存在争议。
立即进行手术切开筋膜对预防ACS的严重后遗症很重要。然而，关于进行筋膜切开术的合适时机以避免不可逆的缺血性改变仍存在争议。治疗ACS最重要的是理解真正的损伤机制，但大多数文献中关于创伤机制的系统分类并不明确。
在观察有水泡的骨折患者后，我们建议处理此类紧急情况的外科医生应保持警惕，筋膜切开术的指征应严格根据损伤机制控制，尤其是对于没有严重软组织损伤的患者。
对于那些挤压伤和软组织损伤，当前基于证据的患者管理策略是有用的，但对于那些与骨折相关的损伤，需要更多检查以避免过度治疗，尤其是对于观察到有水泡的患者。面对患者时，应特别关注病史、损伤机制，对创伤病因进行严格分类是治疗这些患者的关键。
