Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Int Orthop. 2024 Sep;48(9):2475-2481. doi: 10.1007/s00264-024-06233-1. Epub 2024 Jun 14.
Currently no guidance exists within the literature regarding diagnostic criteria or the long-term outcomes for paediatric patients with acute compartment syndrome (ACS). We conducted a retrospective cohort study reviewing all cases of paediatric ACS managed at a single tertiary referral centre with the aim of characterising the factors responsible for the eventual outcomes.
The patient cohort was identified retrospectively by interrogating the hospital coding system for all paediatric patients between January 2014 and November 2022. The electronic emergency department, inpatient and operative notes as well as clinic letters for each patient were reviewed and data collected regarding presentation, associated injuries, management and subsequent complications plus length of follow-up. The data was analysed to determine if differences in presentation or management affected long term outcome.
The final cohort consisted of 34 patients with a mean age of ten years at the time of presentation. The mean time from presentation to fasciotomy was 27.6 h (range 3.0 - 66.6). There was an overall complication rate of 37.5% with a mean follow-up period of 21 months. Patients who had direct closure of their fasciotomy wounds had a significantly lower complications rate and fewer operations compared to those who healed via other wound coverage methods or secondary intention (p < 0.05).
Significantly higher complication rates were observed in patients who were unable to have direct wound closure following emergency fasciotomy. This information may be utilised to rationalise long term treatment plans and in counselling of patients and parents.
目前文献中尚无关于儿科急性骨筋膜室综合征（ACS）患者的诊断标准或长期预后的指南。我们进行了一项回顾性队列研究，对单一三级转诊中心收治的所有儿科 ACS 病例进行了回顾，旨在确定导致最终结局的因素。
通过对 2014 年 1 月至 2022 年 11 月期间所有儿科患者的医院编码系统进行回顾性查询，确定了患者队列。对每位患者的电子急诊、住院和手术记录以及诊所信件进行了审查，并收集了有关就诊时表现、相关损伤、治疗和随后并发症以及随访时间的资料。对数据进行分析，以确定就诊时表现或治疗方法的差异是否会影响长期预后。
最终队列由 34 名患者组成，就诊时的平均年龄为 10 岁。从就诊到筋膜切开术的平均时间为 27.6 小时（范围 3.0-66.6）。总体并发症发生率为 37.5%，平均随访时间为 21 个月。与通过其他伤口覆盖方法或二期愈合的患者相比，直接缝合筋膜切开术伤口的患者并发症发生率显著降低，且需要手术的次数更少（p<0.05）。
在接受紧急筋膜切开术无法直接闭合伤口的患者中，观察到明显更高的并发症发生率。这些信息可用于合理化长期治疗计划，并为患者和家长提供咨询。
