Mortensen Sharri J, Orman Sebastian, Testa Edward J, Mohamadi Amin, Nazarian Ara, von Keudell Arvind G
Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA.
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Eur J Orthop Surg Traumatol. 2020 Jul;30(5):839-844. doi: 10.1007/s00590-020-02643-0. Epub 2020 Feb 27.
Acute compartment syndrome (ACS) is often difficult to diagnose in pediatric patients due to their erratic symptomatology. Therefore, it is of paramount importance to identify at-risk patients to facilitate a prompt diagnosis. This study aims to identify risk factors for the development of ACS in the pediatric population.
We included studies comprised of pediatric patients with traumatic ACS. We excluded studies evaluating compartment syndrome secondary to exertion, vascular insult, abdominal processes, burns, and snake bites. Heterogeneity was addressed by subgroup analysis, and whenever it remained significant, we utilized a random-effects meta-analysis for data pooling. The protocol has been registered at PROSPERO (ID = CRD42019126603).
We included nine studies with 380,411 patients, of which 1144 patients were diagnosed with traumatic ACS. The average age was 10 years old, and 67% of patients were male. Factors that were significantly associated with ACS were: open radius/ulna fractures (OR 3.56 CI 1.52-8.33, p = 0.003), high-energy trauma (OR 3.51 CI 1.71-7.21, p = 0.001), humerus fractures occurring concurrently with forearm fractures (OR 3.49 CI 1.87-6.52, p < 0.001), open tibia fractures (OR 2.29 CI 1.47-3.55, p < 0.001), and male gender (OR 2.06 CI 1.70-2.51, p < 0.001).
In the present study, open fractures, high-energy trauma, concurrent humerus and forearm fractures, and male gender significantly increased the risk of developing ACS in the pediatric population. Clinicians should raise their suspicion for ACS when one or multiple of these factors are present in the right clinical context.
Systematic review and meta-analysis.
III.
由于小儿患者症状不规律，急性筋膜室综合征（ACS）在小儿患者中往往难以诊断。因此，识别高危患者以促进及时诊断至关重要。本研究旨在确定小儿群体中发生ACS的危险因素。
我们纳入了由创伤性ACS小儿患者组成的研究。我们排除了评估因劳累、血管损伤、腹部疾病、烧伤和蛇咬伤继发的筋膜室综合征的研究。通过亚组分析解决异质性问题，当异质性仍然显著时，我们采用随机效应荟萃分析进行数据合并。该方案已在PROSPERO注册（ID = CRD42019126603）。
我们纳入了9项研究，共380411例患者，其中1144例患者被诊断为创伤性ACS。平均年龄为10岁，67%的患者为男性。与ACS显著相关的因素有：开放性桡骨/尺骨骨折（比值比[OR] 3.56，置信区间[CI] 1.52 - 8.33，p = 0.003）、高能创伤（OR 3.51，CI 1.71 - 7.21，p = 0.001）、肱骨骨折与前臂骨折同时发生（OR 3.49，CI 1.87 - 6.52，p < 0.001）、开放性胫骨骨折（OR 2.29，CI 1.47 - 3.55，p < 0.001）以及男性（OR 2.06，CI 1.70 - 2.51，p < 0.001）。
在本研究中，开放性骨折、高能创伤、肱骨和前臂骨折同时发生以及男性显著增加了小儿群体发生ACS的风险。当在正确的临床背景下出现这些因素中的一个或多个时，临床医生应提高对ACS的怀疑。
系统评价和荟萃分析。
III级。
