Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, China.
J Orthop Surg Res. 2024 Apr 20;19(1):252. doi: 10.1186/s13018-024-04719-7.
The primary aim of this study was to investigate the risk factors associated with poor outcomes following acute compartment syndrome (ACS) of lower leg. The secondary objective was to determine if delayed fasciotomy is linked to poor outcomes.
In this retrospective case control study approved by the institutional review board, we identified 103 patients with ACS of the lower leg. Poor outcome was defined as a composite variable that included limb amputation, neurological deficit and contracture. Among these, 44 patients exhibited poor outcome while 59 patients demonstrated a good outcome. Patient-related factors, laboratory values, and treatment-related factors were analyzed using electronic medical records. Univariate statistical and logistic regression analyses were conducted to determine significance.
Bivariate analyses showed that the mechanism of injury (P = 0.021), open injury (P = 0.001), arterial injury (P<0.001), hemoglobin levels (HB) (P < 0.001), white blood cell count (WBC) (P = 0.008), albumin levels (ALB) (P<0.001), creatine kinase levels (CK) at presentation (P = 0.015), CK at peak (P<0.001), creatine kinase levels (Ca) (P = 0.004), dehydrating agent (P = 0.036), and debridement (P = 0.005) were found to be associated with the risk of poor outcomes. Logistic regression analyses revealed that arterial injury [ P< 0.001, OR = 66.172, 95% CI (10.536, 415.611)] was an independent risk factor for poor outcomes. However, HB [P = 0.005, OR = 0.934, 95% CI (0.891, 0.979)] was a protective factor against poor outcomes. Receiver operating characteristic (ROC) curve analysis showed that the cut-off values of HB to prevent poor outcome following ACS was 102.45 g/L.
ACS of the lower leg is a serious complication often associated with a poor prognosis. Patients with arterial injury or lower HB have a significantly increased risk of having poor outcomes. Poor outcomes were not found to be associated with the timing of fasciotomy in this study.
本研究的主要目的是探讨与小腿急性筋膜间室综合征（ACS）不良结局相关的危险因素。次要目的是确定筋膜切开术是否与不良结局有关。
本回顾性病例对照研究经机构审查委员会批准，共纳入 103 例小腿 ACS 患者。不良结局定义为包括截肢、神经功能缺损和挛缩在内的复合变量。其中 44 例患者表现为不良结局，59 例患者表现为良好结局。使用电子病历分析患者相关因素、实验室值和治疗相关因素。采用单变量统计和逻辑回归分析确定显著性。
双变量分析显示，损伤机制（P=0.021）、开放性损伤（P=0.001）、动脉损伤（P<0.001）、血红蛋白水平（HB）（P<0.001）、白细胞计数（WBC）（P=0.008）、白蛋白水平（ALB）（P<0.001）、就诊时肌酸激酶水平（CK）（P=0.015）、峰值时 CK（P<0.001）、钙水平（Ca）（P=0.004）、脱水剂（P=0.036）和清创术（P=0.005）与不良结局的风险相关。逻辑回归分析显示，动脉损伤[P<0.001，OR=66.172，95%CI（10.536，415.611）]是不良结局的独立危险因素。然而，HB[P=0.005，OR=0.934，95%CI（0.891，0.979）]是不良结局的保护因素。受试者工作特征（ROC）曲线分析显示，HB 预防 ACS 后不良结局的截断值为 102.45g/L。
小腿 ACS 是一种严重的并发症，常伴有不良预后。动脉损伤或 HB 较低的患者发生不良结局的风险显著增加。本研究中未发现筋膜切开术的时机与不良结局有关。
