Etemad-Rezaie Ali, Yang Sophia, Kirklys Marit, Higginbotham Devan O, Zalikha Abdul K, Nasr Kerellos
Department of Orthopaedic Surgery, University of Toronto, Toronto, Canada.149 College St Room 508-a, Toronto, ON, M5T 1P5, Canada.
Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, 3333 Green Bay Rd, North Chicago, IL, 60064, United States.
J Orthop. 2022 Apr 30;31:134-139. doi: 10.1016/j.jor.2022.04.014. eCollection 2022 May-Jun.
To review published literature assessing clinical outcomes and complication rates of single incision fasciotomy in fractures of the lower leg.
We searched PubMed and EMBASE for articles published through July 5, 2021, using the terms "single incision fasciotomy", "acute compartment syndrome of the limbs", "compartment syndrome fasciotomy", and "(compartment syndrome fasciotomy) AND (incision)". The inclusion criteria were studies of Level I to IV evidence in English, published in 1970 or later, involving human subjects, reporting clinical outcomes of single incision fasciotomy performed in cases of acute compartment syndrome in lower leg fractures, including at least 1 patient.
Among the 3040 combined total results, 11 primary studies met our inclusion criteria. Adequate and safe compartment release was achieved with single-incision technique. No significant difference was found in terms of complications such as infection and non-union.
The comparative efficacy and safety of single-incision fasciotomy is relatively equal to the two-incision techniques when evaluated in the literature. However, double-incision fasciotomy remains the predominant surgical technique, widely preferred by surgeons due to the familiarity with the technique and ease of full compartment release. In addition to the actual fasciotomy procedure, data suggests that operative timing, closure and fixation techniques can significantly impact patient outcomes. These findings may be used to guide the orthopedic community when determining the optimal incision-type to use in acute compartment syndrome emergencies for lower-extremity fracture cases in conjunction with closure and fixation techniques.
回顾已发表的文献，评估小腿骨折单切口筋膜切开术的临床结局和并发症发生率。
我们在PubMed和EMBASE数据库中检索截至2021年7月5日发表的文章，使用的检索词为“单切口筋膜切开术”、“肢体急性骨筋膜室综合征”、“骨筋膜室综合征筋膜切开术”以及“（骨筋膜室综合征筋膜切开术）AND（切口）”。纳入标准为1970年或之后发表的英文I至IV级证据研究，涉及人类受试者，报告小腿骨折急性骨筋膜室综合征病例中单切口筋膜切开术的临床结局，且至少包含1例患者。
在3040条合并的总结果中，11项初步研究符合我们的纳入标准。单切口技术实现了充分且安全的骨筋膜室减压。在感染和骨不连等并发症方面未发现显著差异。
根据文献评估，单切口筋膜切开术的相对疗效和安全性与双切口技术相当。然而，双切口筋膜切开术仍然是主要的手术技术，由于外科医生对该技术的熟悉程度以及完全骨筋膜室减压的便利性，其被广泛青睐。除了实际的筋膜切开术操作外，数据表明手术时机、闭合和固定技术会显著影响患者结局。这些发现可用于指导骨科领域在确定下肢骨折病例急性骨筋膜室综合征紧急情况下的最佳切口类型时，结合闭合和固定技术进行考量。
