Orthopedics Department, Children's Hospital of Chongqing Medical University, Chongqing, China.
Chongqing Key Laboratory of Pediatrics; Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.
Int Orthop. 2024 Jun;48(6):1481-1487. doi: 10.1007/s00264-023-05984-7. Epub 2023 Sep 21.
Acute compartment syndrome (ACS) is an urgent, critical condition that requires immediate fasciotomy once diagnosed. Traditionally, fasciotomy of the forearms and lower leg involves one or two long approaches. Our previous study demonstrated that mini approaches fasciotomy was an effective method to treat ACS. This study is aimed at further evaluating the limb functions and complications of mini approaches combined with vacuum sealing drainage (VSD) for treating ACS caused by fractures in the forearms and lower legs.
This was a retrospective cross-sectional study, and after applying the inclusion and exclusion criteria, we reviewed 126 children who underwent mini treatment approaches for ACS from Jan 2008 to Jan 2022. The selected patients were divided into two groups: group A (ACS group; 58 patients aged 7.77±3.45 years) and group B (ACS combined with VSD; 68 patients aged 7.17±3.55 years). Patients' clinical data were collected. The patients were followed up, and muscle function in the forearms and lower legs was evaluated.
The overall incidence of lower legs and forearms ACS was 126/29642 (0.425%). The most common mechanisms of injury were fractures of the forearm (39/74, 52.7%), supracondylar humerus (31/74 41.9%), and elbow (4/74, 5.4%), while those for the lower legs were fractures of the proximal tibia (19/52, 36.5%), midshaft of tibia (25/52, 48.1%), and distal tibia (7/52, 13.5%). According to Flynn's assessment, no significant difference was observed between the two groups (p=0.151). However, the two groups showed significant differences in the hospitalization time (p=0.002) and incision infection rate (0.043).
Mini approaches fasciotomy combined with VSD is an effective and safe method to treat ACS of the forearms and lower legs caused by fractures in children. This method involves a single-stage surgery and is associated with shorter hospitalization time and incision infection.
急性筋膜间室综合征（ACS）是一种紧急的危急病症，一旦确诊，需要立即进行筋膜切开术。传统上，前臂和小腿的筋膜切开术需要一个或两个长切口。我们之前的研究表明，微创入路筋膜切开术是治疗前臂和小腿骨折引起的 ACS 的有效方法。本研究旨在进一步评估微创入路联合负压封闭引流（VSD）治疗前臂和小腿骨折引起的 ACS 的肢体功能和并发症。
这是一项回顾性的横断面研究，在应用纳入和排除标准后，我们回顾性分析了 2008 年 1 月至 2022 年 1 月期间 126 例接受微创治疗 ACS 的儿童患者。选择的患者分为两组：A 组（ACS 组；58 例，年龄 7.77±3.45 岁）和 B 组（ACS 合并 VSD 组；68 例，年龄 7.17±3.55 岁）。收集患者的临床资料，进行随访，评估前臂和小腿的肌肉功能。
小腿和前臂 ACS 的总发生率为 126/29642（0.425%）。最常见的损伤机制是前臂骨折（39/74，52.7%）、肱骨髁上骨折（31/74，41.9%）和肘部骨折（4/74，5.4%），而小腿骨折则为胫骨近端骨折（19/52，36.5%）、胫骨中段骨折（25/52，48.1%）和胫骨远端骨折（7/52，13.5%）。根据 Flynn 评估，两组间无显著差异（p=0.151）。然而，两组在住院时间（p=0.002）和切口感染率（0.043）方面存在显著差异。
微创入路筋膜切开术联合 VSD 是一种治疗儿童前臂和小腿骨折引起的 ACS 的有效、安全的方法。该方法采用单阶段手术，具有住院时间短和切口感染率低的优点。
