Jardaly Achraf, Conklin Michael J, Gilbert Shawn R
Department of Orthopedics, Lebanese American University, Gilbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon.
Department of Orthopedics, University of Alabama at Birmingham, Birmingham, AL, USA.
Am J Case Rep. 2021 Feb 27;22:e927082. doi: 10.12659/AJCR.927082.
BACKGROUND Lower-extremity compartment syndrome (CS) is a rare yet devastating complication of posterior spinal fusion. We present our case to discuss this occurrence and possible risk factors. CASE REPORT An obese 15-year-old boy with adolescent idiopathic scoliosis underwent posterior spinal instrumentation and fusion, which was complicated by loss of 5000 mL of blood. He received 11 946 mL of intraoperative infusions to maintain adequate perfusion. Throughout the procedure, his sensory and motor evoked potentials (EPs) were normal. On postoperative Day 1, the patient complained of mild anterior and lateral left leg pain, which became severe by Day 2. Physical examination revealed tense anterior and lateral compartments. He immediately underwent a fasciotomy with irrigation and debridement. On follow-up, the patient has regained full ankle range of motion and has 5/5 dorsiflexion and plantar flexion. He has a weak extensor hallucis longus (1/5) but has been able to fully participate in sports. CONCLUSIONS CS should be suspected when a patient has significant postoperative pain in areas remote from the spine. Risk factors such as excessive blood loss, large volumes of infusion, obesity, prolonged operative time, and EPs can be contributory.
背景 下肢骨筋膜室综合征（CS）是后路脊柱融合术一种罕见但具有毁灭性的并发症。我们通过病例报告来讨论这一情况及可能的危险因素。病例报告 一名肥胖的15岁青少年特发性脊柱侧弯男孩接受了后路脊柱内固定融合术，术中失血5000毫升，出现了并发症。他术中接受了11946毫升的输液以维持充足灌注。整个手术过程中，他的感觉和运动诱发电位（EPs）均正常。术后第1天，患者主诉左小腿前侧和外侧轻度疼痛，到第2天疼痛加剧。体格检查发现小腿前侧和外侧骨筋膜室张力增高。他立即接受了切开减压、冲洗和清创术。随访时，患者踝关节活动范围已完全恢复，背屈和跖屈肌力均为5级。他的拇长伸肌肌力较弱（1/5级），但已能够完全参与体育活动。结论 当患者在远离脊柱的部位出现明显的术后疼痛时，应怀疑骨筋膜室综合征。失血过多、大量输液、肥胖、手术时间延长和诱发电位等危险因素可能与之有关。
