Zhang Dafang, Janssen Stein J, Tarabochia Matthew, von Keudell Arvind, Chen Neal
Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
Harvard Medical School, Boston, MA, 02115, USA.
Eur J Orthop Surg Traumatol. 2020 Feb;30(2):359-365. doi: 10.1007/s00590-019-02563-8. Epub 2019 Sep 27.
The primary objective of this study is to determine whether time from injury to fasciotomy is associated with increased risk for death or limb amputation in patients with acute leg compartment syndrome. The secondary objective of this study is to identify other risk factors for death or limb amputation in patients with acute leg compartment syndrome.
In an institutional review board approved retrospective study, we identified 546 patients with acute compartment syndrome of 558 legs treated with fasciotomies from January 2000 to June 2015 at two Level I trauma centers. Our primary outcome measures were death and limb amputation during inpatient hospital admission. Electronic medical records were analyzed for patient-related factors and treatment-related factors. Bivariate analyses were used to screen for variables associated with our primary outcome measures, and explanatory variables with a p value below 0.05 were included in our multivariable logistic regression analyses.
In-hospital death occurred in 6.6% and in-hospital limb amputation occurred in 9.5% of acute leg compartment syndrome patients. Neither death nor limb amputation was found to be associated with time from injury to fasciotomy. Multivariable logistic regression analyses showed that older age (p = 0.03), higher modified Charlson Comorbidity Index (p = 0.009), higher potassium (p = 0.02), lower hemoglobin (p = 0.002), and higher lactate (p < 0.001) were associated with death, and diabetes mellitus (p = 0.05), no compartment pressure measurement (p = 0.009), higher PTT (p = 0.03), and lower albumin (p = 0.01) were associated with limb amputation.
Time to fasciotomy is not found to be associated with death or limb amputation in acute leg compartment syndrome. Death and limb amputation are associated with patient-related factors and injury severity.
Level III Prognostic.
本研究的主要目的是确定急性小腿骨筋膜室综合征患者从受伤至行筋膜切开术的时间是否与死亡风险或肢体截肢风险增加相关。本研究的次要目的是确定急性小腿骨筋膜室综合征患者死亡或肢体截肢的其他风险因素。
在一项经机构审查委员会批准的回顾性研究中，我们确定了2000年1月至2015年6月期间在两家一级创伤中心接受筋膜切开术治疗的558条腿的546例急性骨筋膜室综合征患者。我们的主要结局指标是住院期间的死亡和肢体截肢。对电子病历进行分析，以获取患者相关因素和治疗相关因素。采用双变量分析筛选与主要结局指标相关的变量，p值低于0.05的解释变量纳入多变量逻辑回归分析。
急性小腿骨筋膜室综合征患者的住院死亡率为6.6%，住院肢体截肢率为9.5%。未发现死亡或肢体截肢与从受伤至行筋膜切开术的时间相关。多变量逻辑回归分析显示，年龄较大（p = 0.03）、改良Charlson合并症指数较高（p = 0.009）、血钾较高（p = 0.02）、血红蛋白较低（p = 0.002）和乳酸较高（p < 0.001）与死亡相关，糖尿病（p = 0.05）、未测量骨筋膜室内压力（p = 0.009）、活化部分凝血活酶时间较高（p = 0.03）和白蛋白较低（p = 0.01）与肢体截肢相关。
在急性小腿骨筋膜室综合征中，未发现行筋膜切开术的时间与死亡或肢体截肢相关。死亡和肢体截肢与患者相关因素及损伤严重程度相关。
三级预后性证据。
