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1、Acute Compartment Syndrome（骨筋膜室综合症）What is compartment syndrome?Definition: An increased pressure within enclosed osteofascial space that reduces capillary per- fusion below level necessary for tissue Viability lead to ischemia and necrosisDemographics Incidence: Men 7.3/100,000 Women0.7/100,000 69%
2、 due to trauma 36% fx tibia 9.8% distal radius 23% soft tissue injury without fx High energy = low energy incidenceEtiology Fractures-closed and open soft tissue injury without fx Temp vascular occlusion Cast/dressing Closure of fascial defects Burns/electrical Surgical positioningPathophysiology:Co
3、mpartment Syndrome Tissue Survival Muscle 3-4 hours - reversible changes 6 hours - variable damage 8 hours - irreversible changes Nerve 0.5hours - Nerve dysfunction 12-24 hours - irreversible changesCLINICAL PRESENTATION Pnt c/o severe pain out of proportion to injury Pain aggravated by passive musc
4、le stretch Loss（dysfunction） of sensation may be useful sign Dorsalis pedis pulse may or may not be affectedDiagnosis History Clinical exam:the Ps Compartment pressures Laboratory tests CPK Urine myoglobinClinical Diagnosis The six Ps: Pressure Pain Paresthesia Paralysis Pallor Pulselessnessswelling
5、Pressure Early finding Only objective finding to Confirm clinical exam Technique Whiteside infusion Wick catheter Slit catheterWhiteside TechniqueTreatmentOrthopaedic Emergency! Lower leg to level of the heart( practical orthopedic P323lift the wounded limbs?) Remove cast Split all dressings down to
6、 skin Fasciotomy if continued clinical findings and/or elevated compartment pressureFasciotomy Principles Make early diagnosis Long extensile incisions to Release all fascial compartments Preserve neurovascular structures Debride necrotic tissues Coverage within 7-10 daysForearmLeg AnatomyLeg Single
7、 Incision TechniqueLeg Two Incision TechniqueHand CompartmentsWound Care Soft tissue coverage with a bulky compression dressing by 5-7 days Second look debridement with consideration for coverage after 48-72 hrs Limb should not be at risk for further swelling Pt should be adequately stabilized DPC(Delayed primary closure) possible if residual swelling is minimal Usually requires skin graft Goal is to obtain definitive coverage within 7-10 days
