Harvard Medical School, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Injury. 2022 Oct;53(10):3481-3485. doi: 10.1016/j.injury.2022.07.035. Epub 2022 Jul 25.
The objective of this study was to identify demographic, injury-related, and treatment-related characteristics of patients who underwent decompressive fasciotomies for acute thigh compartment syndrome.
A cohort of 38 adult patients with acute thigh compartment syndrome treated with fasciotomy at two tertiary care referral centers over a 10-year time period from January 1, 2006 to June 30, 2015 were retrospectively identified. We searched the electronic medical record for patient-related variables (e.g., age, sex, race, smoking status, diabetes mellitus), injury-related variables (e.g., mechanism of injury, associated fractures, other traumatic injuries), treatment-related variables (e.g., delay to treatment, compartments released, number of debridements, use of split-thickness grafts), and outcomes (e.g., amputation, death, sensory/motor impairments at final follow-up).
The mean age of our cohort was 47 years, and 35 patients (92%) were male. There were various mechanisms of injury, but the most common mechanisms were spontaneous hematoma (21%), followed by motor vehicle accidents (16%). Associated leg fractures were present in 15 (39%) patients. Delay between time of injury and fasciotomy was greater than 24 hours in 27 patients (71%), 12 to 24 hours in 6 patients (16%), and less than 6 hours in 3 patients (8%). The most frequently released compartment was the anterior compartment only (68%), followed by both the anterior and posterior compartments (16%) and the posterior compartment only (11%). Six patients (16%) had motor impairment, and 2 patients (5%) had sensory impairment at final follow-up. There were 2 deaths (5%) recorded in the hospital course for this cohort, none of which were directly related to compartment syndrome of the thigh.
Delays to fasciotomy are frequent in the treatment of acute thigh compartment syndrome. The demographics of acute thigh compartment syndrome demonstrate a strong male predominance. Treating providers should recognize spontaneous hematoma and motor vehicle accidents as the most common causes of acute thigh compartment syndrome.
本研究旨在确定接受减压筋膜切开术治疗急性大腿间隔综合征的患者的人口统计学、损伤相关和治疗相关特征。
回顾性分析了 2006 年 1 月 1 日至 2015 年 6 月 30 日期间在 2 家三级转诊中心接受筋膜切开术治疗的 38 例急性大腿间隔综合征成年患者的队列。我们在电子病历中搜索了与患者相关的变量（如年龄、性别、种族、吸烟状况、糖尿病）、损伤相关的变量（如损伤机制、相关骨折、其他创伤性损伤）、治疗相关的变量（如治疗延迟、间隔释放、清创次数、使用中厚皮片移植物）和结果（如截肢、死亡、最终随访时的感觉/运动障碍）。
我们的队列平均年龄为 47 岁，35 名患者（92%）为男性。损伤机制各不相同，但最常见的机制是自发性血肿（21%），其次是机动车事故（16%）。15 名患者（39%）存在腿部骨折。27 名患者（71%）的损伤至筋膜切开术的时间间隔大于 24 小时，6 名患者（16%）的时间间隔为 12-24 小时，3 名患者（8%）的时间间隔小于 6 小时。最常释放的间隔是仅前间隔（68%），其次是前间隔和后间隔（16%）和后间隔仅（11%）。6 名患者（16%）存在运动障碍，2 名患者（5%）在最终随访时有感觉障碍。该队列中有 2 例（5%）死亡记录，均与大腿间隔综合征无关。
急性大腿间隔综合征的筋膜切开术治疗延迟较为常见。急性大腿间隔综合征的人口统计学特征显示出强烈的男性优势。治疗医生应认识到自发性血肿和机动车事故是急性大腿间隔综合征最常见的原因。
