Hessmann M, Rommens P
Department of Traumatology, University Hospitals of the Johannes-Gutenberg-University, Mainz, Germany.
Acta Chir Belg. 1998 Jan-Feb;98(1):18-22.
Pelvic compartment syndrome is a rare condition. As in other musculoskeletal localizations, the intra-compartmental pressure raises above a critical level. In the pelvic compartment syndromes, the gluteal compartments are mainly concerned. We report on three patients with bilateral ureteral obstruction, due to compression by a massive retroperitoneal haematoma as a complication of an unstable pelvic ring or acetabular fracture. Anuria with renal organ failure, due to compression of the ureters in the small true pelvis represents an intrapelvic compartment syndrome. Anuria, due to ureteral compression, mostly developing 24 to 48 hours after injury, has to be differentiated from anuria due to hypovolaemic shock or lesions of the lower urine tract. Bilateral tube nephrostomy represents a temporary and suboptimal therapy. Treatment of the intrapelvic compartment syndrome consists in fracture stabilization and surgical revision of the retroperitoneal space, including evacuation of the haematoma and decompression of the ureters, as it was performed in our patients. Persistent isolated bleeding points can be ligated. If the patient is haemodynamically stable, internal fracture fixation can be performed during the same operative session. A second look procedure may be required for prevention of septic complications.
盆腔间隔综合征是一种罕见疾病。与其他肌肉骨骼部位一样，间隔内压力升高至临界水平以上。在盆腔间隔综合征中，主要涉及臀肌间隔。我们报告了3例双侧输尿管梗阻患者，梗阻原因是不稳定骨盆环或髋臼骨折并发症导致的巨大腹膜后血肿压迫。由于小真骨盆内输尿管受压导致无尿伴肾功能衰竭，这代表盆腔内间隔综合征。因输尿管受压导致的无尿大多在受伤后24至48小时出现，必须与低血容量性休克或下尿路损伤导致的无尿相鉴别。双侧经皮肾造瘘术是一种临时且非最佳的治疗方法。盆腔内间隔综合征的治疗包括骨折固定和腹膜后间隙的手术探查，包括清除血肿和输尿管减压，我们的患者就是这样治疗的。持续性孤立出血点可予以结扎。如果患者血流动力学稳定，可在同一手术过程中进行骨折内固定。可能需要再次手术以预防感染并发症。
