Smith Richard D J, Mortensen Sharri J, Zhang Dafang, Smith Malcolm R, Weaver Michael J, von Keudell Arvind G
Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts.
JB JS Open Access. 2021 Oct 6;6(4). doi: 10.2106/JBJS.OA.21.00038. eCollection 2021 Oct-Dec.
With the worsening opioid epidemic in America, more patients are developing found down extremity compartment syndrome (FDECS). The purpose of this study was to describe this patient population, including their presenting symptoms, laboratory test results, and clinical outcomes.
We performed a 2-center retrospective review of adult patients who developed FDECS secondary to substance use from January 2006 to December 2019. Patients were managed operatively or nonoperatively at the surgeon's discretion. Data on patient demographic characteristics, laboratory values, hospital course, and clinical outcomes were collected from electronic medical records.
In this study, 91 patients were included: 85 patients were managed operatively, and 6 patients were managed nonoperatively. Most patients were male, and the mean patient age (and standard deviation) was 37 ± 11 years. Opioids were the most common substance used. Patients managed operatively underwent a mean of 4 ± 3 surgical procedures, 44% received a skin graft, 25% developed a wound infection, and 11% underwent limb amputation. Patients managed nonoperatively did not undergo a subsequent fasciotomy or amputation. At a mean follow-up of 2.3 years, persistent weakness (66%), pain (78%), persistent sensory deficits (53%), and contractures (18%) were common.
Patients who develop FDECS secondary to substance use have high surgical complication rates and poor clinical outcomes. We found high rates of wound infection, revision surgical procedures, and amputation, often leaving young adults with lifelong disability.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
随着美国阿片类药物流行情况的恶化，越来越多的患者出现下肢筋膜室综合征（FDECS）。本研究的目的是描述这一患者群体，包括他们的症状表现、实验室检查结果及临床结局。
我们对2006年1月至2019年12月因药物使用继发FDECS的成年患者进行了一项双中心回顾性研究。患者由外科医生酌情进行手术或非手术治疗。从电子病历中收集患者的人口统计学特征、实验室值、住院过程及临床结局等数据。
本研究纳入91例患者：85例接受手术治疗，6例接受非手术治疗。大多数患者为男性，患者平均年龄（及标准差）为37±11岁。阿片类药物是最常用的药物。接受手术治疗的患者平均接受4±3次外科手术，44%接受了植皮，25%发生伤口感染，11%接受了肢体截肢。接受非手术治疗的患者未进行后续的筋膜切开术或截肢。平均随访2.3年时，持续肌无力（66%）、疼痛（78%）、持续感觉障碍（53%）和挛缩（18%）很常见。
因药物使用继发FDECS的患者手术并发症发生率高，临床结局差。我们发现伤口感染、再次手术和截肢的发生率很高，常使年轻人终身残疾。
预后IV级。有关证据水平的完整描述，请参阅作者指南。
