Warren Madeline, Dhillon Govind, Muscat Joseph, Abdulkarim Ali
Trauma and Orthopaedics, East and North Hertfordshire NHS Trust, Stevenage, GBR.
Trauma and Orthopaedics, University Hospitals Sussex NHS Foundation Trust, Brighton, GBR.
Cureus. 2021 Dec 8;13(12):e20256. doi: 10.7759/cureus.20256. eCollection 2021 Dec.
Bilateral acute compartment syndrome of the legs is a very rare presentation that requires emergency surgical intervention. Atraumatic bilateral cases are almost unheard of in medicine. There is currently no link between compartment syndrome and cognitive impairment or mental health. A systematic literature search was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines using the following keywords in multiple databases: compartment syndrome, atraumatic, spontaneous, bilateral, both, lower leg, acute, compartmental pressure, and fasciotomy. Atraumatic, bilateral, acute, and confirmed compartment syndrome cases were included. In total, 33 cases of atraumatic bilateral acute compartment syndrome (ABACS) were identified, of those 72.7% of cases were males. A form of cognitive impairment was found in 66% of cases. The medical history of the cases included substance abuse (nine patients), mental health illness (seven patients), and hypothyroidism (four patients). Within the reports, there was evidence of a misdiagnosis or delayed management in 19 cases (57.6%). Creatinine kinase (CK) was measured in 28 cases with a mean CK of 110,893 IU/L. Compartment pressure measurements were used in only 12 cases. A total of 29 cases were managed with bilateral four-compartment fasciotomy. This review highlights that ABACS is a condition with high rates of misdiagnosis or delay in treatment. Associations found included patients with cognitive impairment on presentation, mental health conditions, substance misuse, and elevated levels of CK. In addition, this review demonstrates that this condition is less rare than previously thought with serious morbidity and mortality.
双侧小腿急性骨筋膜室综合征是一种非常罕见的病症，需要紧急手术干预。医学上几乎从未听说过非创伤性双侧病例。目前骨筋膜室综合征与认知障碍或心理健康之间没有关联。按照系统评价和Meta分析的首选报告项目指南，在多个数据库中使用以下关键词进行了系统的文献检索：骨筋膜室综合征、非创伤性、自发性、双侧、双下肢、急性、骨筋膜室内压力和筋膜切开术。纳入非创伤性、双侧、急性且确诊的骨筋膜室综合征病例。总共确定了33例非创伤性双侧急性骨筋膜室综合征（ABACS）病例，其中72.7%为男性。66%的病例存在某种形式的认知障碍。病例的病史包括药物滥用（9例患者）、心理健康疾病（7例患者）和甲状腺功能减退（4例患者）。在报告中，有19例（57.6%）存在误诊或治疗延迟的证据。对28例患者测量了肌酸激酶（CK），平均CK为110,893 IU/L。仅12例进行了骨筋膜室内压力测量。共有29例接受了双侧四室筋膜切开术治疗。本综述强调，ABACS是一种误诊率或治疗延迟率很高的病症。发现的关联包括就诊时存在认知障碍的患者、心理健康状况、药物滥用以及CK水平升高。此外，本综述表明，这种病症并不像以前认为的那么罕见，具有严重的发病率和死亡率。
