Elkbuli Adel, Sanchez Carol, Hai Shaikh, McKenney Mark, Boneva Dessy
Department of Surgery, Kendall Regional Medical Center, Miami, FL, USA.
University of South Florida, Tampa, FL, USA.
Ann Med Surg (Lond). 2019 Jul 11;44:98-101. doi: 10.1016/j.amsu.2019.07.010. eCollection 2019 Aug.
A compartment syndrome (CS) occurs when increased pressure within an anatomic compartment leads to inadequate perfusion. Although rare, gluteal CS can be encountered when an unconscious person has a prolonged period of immobilization.
A 20-year-old male with history of polysubstance abuse leading to passing out, presented with right buttock and lower extremity pain, increased creatinine phosphokinase (CPK), and acute renal failure. Physical examination and MRI confirmation supported gluteal CS. Patient was taken to the OR for gluteal fasciotomy. Afterwards, the pain improved, the CPK and creatinine trended to normal. He was discharged home on day 7.
CS can occur in any part of the body with fascial compartments. Increased compartmental pressure causes compression of vessels and nerves in the area that can lead to ischemia and necrosis. CS can occur after trauma, excessive fluid resuscitation, or surgery. It is also reported due to the prolonged periods of immobilization and increasing pressure on dependent areas. Often, intra-compartmental pressure is measured to confirm the diagnosis. The mainstay of treatment is fasciotomy.
Due to the rarity of gluteal compartment syndrome, the diagnosis is often delayed. If the affected area is ischemic for a significant amount of time, it can lead to sciatic nerve palsy, paresthesias, paralysis and muscle necrosis. Patients may experience irreversible damage after the syndrome and as such providers should be cognizant of this clinical entity to make an early diagnosis of gluteal compartment syndrome.
当解剖间隙内压力升高导致灌注不足时，就会发生骨筋膜室综合征（CS）。臀肌骨筋膜室综合征虽然罕见，但在无意识的人长时间固定不动时可能会出现。
一名20岁男性，有多种物质滥用史并导致昏迷，出现右臀部和下肢疼痛、肌酸磷酸激酶（CPK）升高及急性肾衰竭。体格检查和MRI确诊为臀肌骨筋膜室综合征。患者被送往手术室行臀肌筋膜切开术。术后，疼痛缓解，CPK和肌酐水平趋于正常。他于第7天出院。
骨筋膜室综合征可发生于任何有筋膜间隙的身体部位。间隙内压力升高会导致该区域血管和神经受压，进而导致缺血和坏死。骨筋膜室综合征可发生于创伤、过度液体复苏或手术后。也有报道称其与长时间固定及受压部位压力增加有关。通常，需测量间隙内压力以确诊。治疗的主要方法是筋膜切开术。
由于臀肌骨筋膜室综合征罕见，诊断往往延迟。如果受影响区域缺血时间过长，可导致坐骨神经麻痹、感觉异常、瘫痪和肌肉坏死。患者在该综合征发生后可能会遭受不可逆的损害，因此医护人员应认识到这一临床实体，以便早期诊断臀肌骨筋膜室综合征。
