McQueen M
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Scotland.
Acta Chir Belg. 1998 Aug;98(4):166-70.
Acute compartment syndrome is a serious complication of injury. It occurs when raised pressure within a closed osteofascial compartment compromises the circulation and function of tissues within the compartment. Most cases are caused by fracture. The largest group are tibial diaphyseal fractures, followed by soft tissue injury, crush syndrome, distal radial fractures and forearm diaphyseal fractures. Those at risk of developing acute compartment syndrome are young males, patients with bleeding disorders or on anticoagulant therapy and in the upper limb, high energy injury. The clinical symptoms and signs of acute compartment syndrome are pain, stretch pain and neurological abnormality, none of which are constantly present. Since early diagnosis of this condition is of paramount importance compartment monitoring is recommended. The recommended tissue pressure threshold for decompression has been variable through the years but should be related to the patient's blood pressure. A difference of less than 30 mmHg between the diastolic and tissue pressures has been validated clinically and it is recommended that at this level serious consideration should be given to decompression of the affected compartments. Use of this pressure threshold with compartment monitoring has been shown to half the delay to fasciotomy and significantly reduces the late complications of acute compartment syndrome.
急性骨筋膜室综合征是一种严重的损伤并发症。当封闭的骨筋膜室内压力升高，损害该室内组织的血液循环和功能时，就会发生这种情况。大多数病例由骨折引起。其中最常见的是胫骨干骨折，其次是软组织损伤、挤压综合征、桡骨远端骨折和前臂骨干骨折。有发生急性骨筋膜室综合征风险的人群包括年轻男性、有出血性疾病或正在接受抗凝治疗的患者，以及上肢遭受高能损伤的患者。急性骨筋膜室综合征的临床症状和体征包括疼痛、牵拉痛和神经功能异常，但这些症状并非都会出现。由于早期诊断至关重要，因此建议进行骨筋膜室监测。多年来，推荐的减压组织压力阈值有所不同，但应与患者血压相关。舒张压与组织压力之间相差小于30 mmHg已得到临床验证，建议在这一水平时应认真考虑对受影响的骨筋膜室进行减压。使用该压力阈值并结合骨筋膜室监测已被证明可将切开筋膜减压的延迟时间减半，并显著减少急性骨筋膜室综合征的晚期并发症。
