Heckman M M, Whitesides T E, Grewe S R, Rooks M D
Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia.
J Bone Joint Surg Am. 1994 Sep;76(9):1285-92. doi: 10.2106/00004623-199409000-00002.
We studied twenty-five consecutive patients who had a closed tibial fracture to determine whether there was a relationship between compartment pressure and the distance at which the pressure was measured from the site of the fracture. Tissue pressure was measured in all four compartments of the leg at the level of the fracture and at five-centimeter increments proximal and distal to the fracture. The peak pressure was usually found at the level of the fracture and was always located within five centimeters of the fracture. The highest pressures were recorded in the anterior and the deep posterior compartments in twenty patients, including all five of those who had had a fasciotomy. The measured pressure decreased steadily when sampled at increasing distances proximal and distal to the site of the highest recorded pressure. Decreases of twenty millimeters of mercury (2.67 kilopascals) five centimeters adjacent to the site of the peak pressure were common. Compartment syndrome was diagnosed in five patients on the basis of clinical findings, and the diagnosis was confirmed when peak compartment pressures of more than the critical threshold (within twenty millimeters of mercury [2.67 kilopascals] of the diastolic blood pressure) were recorded. Three of these five patients had measured pressures that were less than the critical threshold within five centimeters of the site of the peak pressure. Failure to measure tissue pressure within a few centimeters of the zone of peak pressure may result in a serious underestimation of the maximum compartment pressure. Our results suggest that measurements should be performed in both the anterior and the deep posterior compartments at the level of the fracture as well as at locations proximal and distal to the zone of the fracture to determine reliably the location of the highest tissue pressure in a lower extremity when a compartment syndrome is suspected clinically. The highest pressure should be used in the decision-making process.
我们研究了连续25例闭合性胫骨骨折患者，以确定骨筋膜室压力与从骨折部位测量压力处的距离之间是否存在关联。在骨折水平以及骨折近端和远端每隔5厘米处测量小腿所有四个骨筋膜室的组织压力。峰值压力通常出现在骨折水平，且总是位于距骨折处5厘米范围内。20例患者的前侧和后侧深部骨筋膜室记录到最高压力，其中包括所有5例行筋膜切开术的患者。在记录到最高压力部位的近端和远端，随着采样距离增加，所测压力稳步下降。在峰值压力部位相邻5厘米处压力下降20毫米汞柱（2.67千帕斯卡）很常见。根据临床表现诊断出5例骨筋膜室综合征，当记录到骨筋膜室峰值压力超过临界阈值（舒张压20毫米汞柱[2.67千帕斯卡]以内）时，诊断得到证实。这5例患者中有3例在峰值压力部位5厘米范围内所测压力低于临界阈值。未能在峰值压力区域几厘米范围内测量组织压力可能导致严重低估最大骨筋膜室压力。我们的结果表明，当临床上怀疑骨筋膜室综合征时，应在骨折水平以及骨折区域近端和远端的前侧和后侧深部骨筋膜室进行测量，以可靠地确定下肢最高组织压力的位置。在决策过程中应使用最高压力。
