Demir Ekin Barış, Barça Fatih, Atilla Halis Atıl, Çevik Kadir, Tam Emre, Atlı Osman Yağız, Yüksel Sinan, Emet Abdülsamet, Çatma Mehmet Faruk, Duman Evrim, Fırat Ahmet, Akdoğan Mutlu
Ankara Etlik City Hospital, Ankara, Turkey.
Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey.
Eur J Trauma Emerg Surg. 2025 Jan 24;51(1):42. doi: 10.1007/s00068-024-02710-9.
This study was planned to evaluate limb survival and clinical outcomes of fasciotomies done before and after 24-48 h due to compartment syndrome in the extremities caused by crush injuries after the earthquakes in Turkey on February 6-7, 2023.
We retrospectively analyzed 129 extremities of 84 patients that underwent fasciotomy after the 2023 Turkey earthquakes in this single center study. Demographical data of patients, affected limb, time to fasciotomy, limb survival, number of debridements, necrotic muscle debridement, whether graft-flap was needed, and the need for hemodialysis were analyzed. Extremities were grouped according to timing of fasciotomy (24-48 h) and subgroups were defined in terms of affected limb (upper/lower).
43 females (51.2%) and 41 males (48.8%) were included in the study. Mean age of patients was 34.5 ± 12.8 years. There were 39 upper, 90 lower extremities totaling 129. Amputations were performed in 25 (19.4%) extremities of 20 (23.8%) patients of which 5 were upper (5 transhumeral) and 20 were lower (3 hip disarticulation, 7 transfemoral, 10 transtibial). There was no need for amputation in patients fasciotomised within 24 h. Amputation was performed in 9 (11.5%) of 78 extremities fasciotomized between 24 and 48 h and in 16 (31.4%) of 51 extremities fasciotomized after 48 h (p = 0.005). Amputation rates were significantly higher in lower extremities after 48 h (p = 0.002) in contrast to upper extremities (p = 0.661). The median number of debridements in all extremities was 2 [1-4]. Muscle compartment excision was required in 27 extremities (%26). Of the remaining 34 upper extremities, 17 (50.0%) were closed with graft/flap application and of the remaining 70 lower extremities, 25 (35.7%) were closed with graft/flap application. 19 patients (22.6%) received hemodialysis, with significantly higher rate with late fasciotomies (p < 0.001 and 0.004 for 24 h and 48 h respectively).
Fasciotomies earlier than 24 h prevented amputation and rate of muscle compartment excision was higher in fasciotomies done after 24 h especially for lower extremities. Upper extremity fasciotomy timing early or late did not change the outcomes.
本研究旨在评估2023年2月6 - 7日土耳其地震后因挤压伤导致肢体骨筋膜室综合征而行筋膜切开术的时间在24 - 48小时之前和之后的肢体存活率及临床结局。
在这项单中心研究中，我们回顾性分析了2023年土耳其地震后接受筋膜切开术的84例患者的129条肢体。分析了患者的人口统计学数据、受累肢体、筋膜切开术时间、肢体存活率、清创次数、坏死肌肉清创情况、是否需要植皮/皮瓣以及是否需要血液透析。根据筋膜切开术时间（24 - 48小时）对肢体进行分组，并根据受累肢体（上肢/下肢）定义亚组。
本研究纳入43名女性（51.2%）和41名男性（48.8%）。患者的平均年龄为34.5±12.8岁。共有39条上肢、90条下肢，总计129条肢体。20例（23.8%）患者的25条（19.4%）肢体进行了截肢，其中5条为上肢（5例经肱骨截肢），20条为下肢（3例髋关节离断、7例经股骨截肢、10例经胫骨截肢）。在24小时内接受筋膜切开术的患者无需截肢。在24至48小时之间接受筋膜切开术的78条肢体中有9条（11.5%）进行了截肢，在48小时后接受筋膜切开术的51条肢体中有16条（31.4%）进行了截肢（p = 0.005）。与上肢相比（p = 0.661），48小时后下肢的截肢率显著更高（p = 0.002）。所有肢体清创的中位数为2次[1 - 4次]。27条肢体（26%）需要进行肌肉筋膜室切除。其余34条上肢中，17条（50.0%）通过植皮/皮瓣应用进行闭合，其余70条下肢中，25条（35.7%）通过植皮/皮瓣应用进行闭合。19例患者（22.6%）接受了血液透析，晚期筋膜切开术患者的透析率显著更高（24小时和48小时分别为p < 0.001和0.004）。
24小时之前进行筋膜切开术可预防截肢，24小时之后进行的筋膜切开术，尤其是下肢，肌肉筋膜室切除率更高。上肢筋膜切开术的早晚不改变结局。
