Field C K, Senkowsky J, Hollier L H, Kvamme P, Saroyan R M, Rice J C, Rush D S, Kerstein M D
Department of Surgery, Hahnemann University School of Medicine, Philadelphia, Pennsylvania 19102-1192.
Am Surg. 1994 Jun;60(6):409-11.
Fasciotomy has been used as a prophylactic measure against development of compartment syndrome and as a treatment modality when the syndrome has developed in patients suffering vascular trauma. The hospital records of 36 patients who underwent surgical repair of their traumatic vascular injuries were reviewed. All 36 patients had at least one indication for fasciotomy at the time of repair; i.e., ischemic time of more than 6 hours or combined arterial and venous injury. Prophylactic fasciotomies were performed in 18 of the patients at the time of vascular repair; 18 did not have fasciotomies performed at the time of initial repair. The decision to perform a fasciotomy was made by the operating surgeon based on well-defined criteria. Hospital stay was significantly longer for the fasciotomy group. Four of the fasciotomy-related complications were infective in nature. Only one patient who did not undergo fasciotomy at the time of original repair developed a compartment syndrome during the postoperative period. Selective fasciotomy based on well-defined criteria instead of serial physical examinations or measurement of compartment pressures will effectively save limbs; there is an increased hospital stay.
筋膜切开术已被用作预防骨筋膜室综合征发展的措施，以及在血管创伤患者发生该综合征时的一种治疗方式。回顾了36例接受创伤性血管损伤手术修复患者的医院记录。所有36例患者在修复时至少有一项进行筋膜切开术的指征，即缺血时间超过6小时或合并动静脉损伤。18例患者在血管修复时进行了预防性筋膜切开术；18例在初次修复时未进行筋膜切开术。是否进行筋膜切开术由手术医生根据明确的标准决定。筋膜切开术组的住院时间明显更长。4例与筋膜切开术相关的并发症本质上是感染性的。只有1例在初次修复时未进行筋膜切开术的患者在术后发生了骨筋膜室综合征。基于明确标准而非连续体格检查或测量骨筋膜室内压力进行选择性筋膜切开术将有效地挽救肢体；但住院时间会延长。
