McCarthy D M, Sotereanos D G, Towers J D, Britton C A, Herndon J H
Department of Orthopaedic Surgery, University of Pittsburgh, PA, USA.
Clin Orthop Relat Res. 1995 Mar(312):266-70.
The diagnosis of compartment syndrome is essentially a clinical one. In recent years, much interest and research has focused on the development of intracompartmental pressure monitoring devices to help in the diagnosis of this condition. Proper placement of the catheter is essential for accurate monitoring, because an incorrect result is potentially more dangerous than no reading at all. In the forearm, measurement in the flexor digitorum profundus is thought to be a more sensitive way of assessing rising pressure. One of the risks of catheter placement is inadvertent damage to a neurovascular structure, particularly when monitoring pressures in deeper muscle bellies. Standard anatomic texts and outpatient magnetic resonance scans of the forearm were studied to define a safe pathway for the introduction of a catheter into the volar forearm. An approach from the midline to the ulna, between the tendons of the flexor carpi radialis and palmaris longus, seemed the safest. Ten cadaveric forearms had 100 cc of gastrograffin injected into the deep forearm through a dorsal approach. The median and ulnar nerves were cannulated with a fine wire from the elbow to the wrist. Two cannulae were passed, using the suggested approach, at 2 locations between the wrist and the mid forearm. All limbs then were scanned with computed tomography, and the images were reviewed. In all forearms, the cannulae passed between the median and ulnar nerves into the belly of the flexor digitorum profundus and posed no risk to the neurovascular structures.
骨筋膜室综合征的诊断本质上是临床诊断。近年来，人们对骨筋膜室内压力监测设备的开发给予了极大关注并进行了大量研究，以帮助诊断这种病症。导管的正确放置对于准确监测至关重要，因为错误的结果可能比根本没有读数更危险。在前臂，测量指深屈肌内的压力被认为是评估压力升高的更敏感方法。导管放置的风险之一是意外损伤神经血管结构，特别是在监测较深肌腹的压力时。研究了标准解剖学文献和前臂的门诊磁共振扫描，以确定将导管引入掌侧前臂的安全路径。从中线到尺骨，在桡侧腕屈肌腱和掌长肌腱之间的入路似乎是最安全的。十具尸体前臂通过背侧入路将100 cc泛影葡胺注入前臂深部。用细钢丝从肘部到腕部插入正中神经和尺神经。使用建议的入路，在腕部和前臂中部之间的两个位置插入两根套管。然后对所有肢体进行计算机断层扫描，并对图像进行评估。在所有前臂中，套管均从正中神经和尺神经之间穿过，进入指深屈肌肌腹，对神经血管结构无风险。
