Christian Medical College, Vellore 632004, Tamil Nadu, India.
Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia.
Chin J Traumatol. 2021 Mar;24(2):109-112. doi: 10.1016/j.cjtee.2020.11.006. Epub 2020 Nov 20.
Impending compartment syndrome is a common event following closed tibia fractures, which can progress to sinister compartment syndrome. Fasciotomy is the only definitive treatment available, though it has its own drawbacks and complications. Medical management at present consists of limb elevation and adequate hydration. This study aims at determining whether intravenous administration of Mannitol reduced the intracompartmental pressure in patients with closed tibial fractures.
This is a double blinded, randomized control trial done in a single tertiary care center in India. Forty-five patients were recruited between February 2012 and October 2012. Forty patients who presented to the emergency department with isolated, closed, high velocity, and proximal 2/3 tibia fractures were included in this study. Patients with contraindication to Mannitol were excluded. They were allocated into 2 groups by the investigator using computer generated randomization. The pressure in the anterior compartment of the leg was measured with a handheld Stryker pressure monitor. Then either 20% Mannitol or 0.9% normal saline as given intravenously in a blinded manner, based on the randomization. The intracompartmental pressure was measured at 0, 1 and 3 h after the infusion. The participant, investigator and statistician were masked to the group assessment.
There was no difference in intracompartmental pressures at 1 or 3 h, between the groups. However, in patients with the baseline of compartmental pressures ≥30 mmHg, Mannitol showed a marked reduction in pressure of 8.5 mmHg at 1 h compared to almost no change in pressure in the saline group. There were no adverse events with the use of Mannitol.
This preliminary study appears to show that Mannitol is useful in the management of the increased compartment pressure. The limitations of this study were that it only involved a small group of patients and the baseline pressures in both the groups were not comparable. More studies are required before the use of Mannitol as a standard of care in the management of compartment syndrome can be established.
在闭合性胫骨骨折后，即将发生的筋膜间室综合征是一种常见的情况，其可能进展为严重的筋膜间室综合征。筋膜切开术是唯一可行的确定性治疗方法，但它有其自身的缺点和并发症。目前的医学治疗包括肢体抬高和充分补液。本研究旨在确定静脉内给予甘露醇是否能降低闭合性胫骨骨折患者的骨间室内压力。
这是在印度一家单一的三级护理中心进行的一项双盲、随机对照试验。2012 年 2 月至 2012 年 10 月期间共招募了 45 名患者。本研究纳入了 40 名因孤立性、闭合性、高速和胫骨近端 2/3 骨折而到急诊科就诊的患者。排除了对甘露醇有禁忌症的患者。研究者通过计算机生成的随机化将患者分配到 2 组。使用手持式 Stryker 压力监测仪测量腿部前室的压力。然后根据随机分组，以盲法静脉给予 20%甘露醇或 0.9%生理盐水。在输注后 0、1 和 3 小时测量骨间室内压力。参与者、研究者和统计学家对组间评估均设盲。
两组在 1 或 3 小时时骨间室内压力均无差异。然而，在基线骨间室内压力≥30mmHg 的患者中，与生理盐水组压力几乎无变化相比，甘露醇在 1 小时时显示出 8.5mmHg 的明显压力降低。使用甘露醇无不良反应。
这项初步研究似乎表明，甘露醇在管理增加的骨间室压力方面是有用的。本研究的局限性在于仅涉及一小部分患者，并且两组的基线压力不可比。在将甘露醇作为筋膜间室综合征管理的标准治疗方法之前，还需要进行更多的研究。
