骨筋膜室综合症（近十年）

骨筋膜室综合症（近十年） 骨筋膜室综合症 Acute Compartment Syndrome of the Forearm Secondary to Infection Within the Space of Parona 摘要: The deep midpalmar space of the hand communicates with the space of Parona in the forearm. Infection of these deep spaces can be difficult to diagnose. This article presents the first reported case of acute compartment syndrome of the forearm secondary to infection within the space of Parona. This article discusses the anatomy of the space of Parona, highlighting its communicating spaces and the importance of recognizing a deep-space infection of the hand as a possible cause of compartment syndrome of the forearm. This article also suggests a method of clinical examination to aid in the diagnosis of infection within the space of Parona to allow more specific planning of surgical intervention through early decompressive surgery, with surgical exploration to exclude and drain infection when no other clear cause for the rise in pressure within the osteofascial compartment is apparent. Compression syndromes of the popliteal neurovascular bundle due to Baker cyst 摘要: Background: The purpose of this study was to perform a comprehensive search of the literature for all studies, case reports, and series describing Baker cyst compression of the neurovascular bundle in the popliteal fossa and index their findings according to the structures compressed. Method: Case reports and series obtained after a thorough MEDLINE search were indexed according to compressed structures. Patient demographics, main findings, method of diagnosis, cyst size, outcomes, and follow-up were recorded for each publication. Results: Signs and symptoms related to popliteal vein and tibial nerve compression were the most frequent presentation of symptomatic Baker cysts, due to the anatomic vulnerability of these structures within the popliteal fossa and their relative sensitivity to compression. Patients with tibial nerve entrapment demonstrated gastrocnemius muscle atrophy, paresthesias, and pain. Those with popliteal vein compression experienced swelling, pain, and rarely, venous thromboembolism. Isolated arterial compression, presenting with intermittent claudication, is a rare occurrence because it is a relatively stiff-walled vessel, has a higher pressure, and is located deep in the popliteal fossa. Combinations of these compression syndromes are most frequently encountered in the context of cyst rupture and resulting compartment syndrome. Conclusions: Baker cyst is an important pathology for the differential diagnosis of popliteal neurovascular compression phenomena. It has a wide spectrum of presentation, therefore requiring accurate diagnosis for proper patient management. Because Baker cyst is by definition a chronic disorder, long-term follow-up is necessary to monitor patient recovery and prevent recurrence. (J Vase Surg 2011;54:1821-9.) 1 Compartment Syndrome of the Forearm: A Systematic Review 摘要: In this systematic review, we examined the available evidence regarding compartment syndrome of the forearm. Applying our inclusion criteria, we found 12 articles for a total of 84 cases using the MEDLINE (Ovid) database. All were retrospective studies (level IV evidence). In this study, papers were analyzed for causes, diagnosis, treatment, methods of wound closure, functional outcome, and complications. The most common cause of compartment syndrome of the forearm in children was a supracondylar fracture, while in adults the most common cause was a fracture of the distal radius. The diagnostic criterion used was clinical assessment alone in 48%, and in 52%, a combination of measurement of intracompartmental pressure and clinical assessment was used. The intracompartmental pressure was measured using various techniques including a wick catheter, slit catheter, the Whitesides technique, and the Stryker compartment pressure measuring device. Fasciotomy was the preferred method of treatment (73%). In cases reporting wound management, postfasciotomy skin grafting was needed in 61% of the cases, whereas secondary closure was performed in 39% of the cases. Neurological deficit was the most common complication (21%). (J Hand Surg 2011;36A:535-543. 2011 Published by Elsevier Inc. on behalf of the American Society for Surgery of the Hand.) Current thinking about acute compartment syndrome of the lower extremity 摘要: Acute compartment syndrome of the lower extremity is a clinical condition that, although uncommon, is seen fairly regularly in modern orthopedic practice. The pathophysiology of the disorder has been extensively described and is well known to physicians who care for patients with musculoskeletal injuries. The diagnosis, however, is often difficult to make. In this article, we review the clinical risk factors of acute compartment syndrome of the lower extremity, identify the current concepts of diagnosis and discuss appropriate treatment plans. We also describe the Canadian medicolegal environment in regard to compartment syndrome of the lower extremity. Compartment Syndrome and Lower-Limb Fasciotomies in the Combat Environment 摘要: Prophylactic and therapeutic treatment of leg compartment syndrome with decompression by double-incision fasciotomy prevents progression of soft-tissue injury in high-energy trauma. This treatment is the standard of care in civilian trauma and combat settings. More controversial is the use of either single- or dual-incision fasciotomy of the foot for prophylactic treatment of foot compartment syndrome. Fasciotomy must be performed in the face of major trauma to the foot with severe swelling and unremitting pain. The role for prophylactic fasciotomy of the foot is unclear and should be considered on a case by case basis. The surgeon must maintain a high degree of vigilance for the development of compartment syndrome in the combat casualty. A careful physical examination is required and pressure measurements serve as an adjunct in making the diagnosis in the deployed setting. Future advances in 2 the understanding of pathophysiology and diagnosis of compartment syndrome may reduce the currently maintained low threshold for fasciotomy to avoid the devastating consequences of a missed diagnosis. Compartment syndrome of the thigh: A systematic review 摘要: Introduction: Thigh compartment syndrome is a surgical emergency with risk of high morbidity and mortality rates. The purpose of this study was to review the available evidence regarding the causes of thigh compartment syndrome, techniques of fasciotomy (specifically, one versus two incisions), methods of wound closure, and complications. Methods: This institutional review board-exempt study was performed at a level-one trauma centre. PubMed and Medline OVID databases in the English language were searched for case series of two or more cases of compartment syndrome of the thigh. Cases were reviewed and analysed for causes of thigh compartment syndrome, number of fasciotomy incisions, methods of wound closure, and complications. Results: A total of 9 papers met our criteria. All were retrospective case studies comprising a total of 89 patients. The most common Cause was blunt trauma (90%). Motor vehicle accidents accounted for 36% of cases whilst motorcycle accidents were involved in 9%. Associated injuries included femur fractures in 48%, other limb fractures, renal, cardiovascular and head insults. Eighty-six percent of fasciotomies were performed through a single incision. Fifty-nine percent of fasciotomy wounds were closed by delayed primary closure, 26% had split-thickness skin grafts, and 15% had primary wound closure. Neurological deficits were the most common complications. Conclusion: There are limited data on thigh compartment syndrome with respect to cause, use of one versus two incisions for fasciotomy, methods Of Wound closure, and complication rates. Prospective studies are required to better define these variables in order to optimise the management of this problem. (C) 2009 Elsevier Ltd. All rights reserved Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis dagger 摘要: Acute compartment syndrome can cause significant disability if not treated early, but the diagnosis is challenging. This systematic review examines whether modern acute pain management techniques contribute to delayed diagnosis. A total of 28 case reports and case series were identified which referred to the influence of analgesic technique on the diagnosis of compartment syndrome, of which 23 discussed epidural analgesia. In 32 of 35 patients, classic signs and symptoms of compartment syndrome were present in the presence of epidural analgesia, including 18 patients with documented breakthrough pain. There were no randomized controlled trials or outcome-based comparative trials available to include in the review. Pain is often described as the cardinal symptom of compartment syndrome, but many authors consider it unreliable. Physical examination is also unreliable for diagnosis. There is no convincing evidence that patient-controlled analgesia opioids or regional analgesia delay the diagnosis of compartment syndrome provided patients are adequately monitored. Regardless of the type 3 of analgesia used, a high index of clinical suspicion, ongoing assessment of patients, and compartment pressure measurement are essential for early diagnosis. Salvage of compartment syndrome of the leg and foot. 摘要: Early diagnosis and treatment of compartment syndrome of the leg or foot is invaluable in avoiding a chronic and often debilitating course. In cases where an ischemic contracture results in pain, disability or soft tissue compromise, surgical intervention is indicated. Thorough physical examination of patients and a thorough understanding of pathomechanics of the foot and ankle are paramount. These combined with a comprehensive preoperative plan and meticulous execution can often provide improved function and decrease pain in patients affected by this debilitating problem. Compartment syndrome of the lower leg and foot. Anatomy and pathophysiology 摘要: Due to the unique anatomy and pathophysiology involved, a compartment syndrome (CS) of the lower leg and foot is prone to develop sequelae that demand operative reconstruction. Moreover, the two regions are closely related. Although research into various pathophysiological areas is revealing specific complexities, aspects of the foot's compartmental anatomy remain controversial, perhaps because of methodological reasons. This may result in particular practices for diagnosing and treating CS in this region, which are discussed in this article. Functional reconstruction after compartment syndrome of the forearm and hand 摘要: Ischemic muscle contracture after a compartment syndrome of the forearm and hand may result in severe loss of function. In addition to the established muscle contracture, a loss of nerve and vessel function can often be found. The clinical appearance depends on the involved muscles respectively compartments. Even though each case requires individual analysis of the clinical situation, the combination of Tsuge's classification with Holden's classification provides a more or less systematic approach to treatment that can be adapted to each case according to the severity of the contracture of the joints and muscles, the degree of nerve and vessel damage, the function of the remaining muscles and nerves, and the availability of other functioning muscles for reconstruction. Management of forearm compartment syndrome 摘要: Compartment syndrome of the forearm is a serious medical problem, and it is commonly associated with high-energy injuries to the upper extremity. Timely recognition and treatment are critical to ensuring a good outcome and avoiding permanent functional loss. The diagnosis is primarily based on 4 clinical suspicion. Surgical intervention with fasciotomy is the mainstay of treatment. Reconstruction of the foot after leg or foot compartment syndrome. 摘要: Compartment syndrome should be treated early and aggressively to prevent late complications. Patients may have late deformity because of a failure of diagnosis, inadequate decompression, or a delay in fasciotomies. Late reconstruction will allow a plantigrade and relatively functional foot. Complete excision of scarred muscle will prevent recurrence in established deformities. Early treatment may prevent significant functional impairment by well-placed tenotomies. In patients with severe long-term deformities with extensive soft tissue contraction, incremental correction may be an appropriate intermediate intervention. The secondary abdominal compartment syndrome: Iatrogenic or unavoidable? Reconstruction of the foot after leg or foot compartment syndrome. Compartment syndrome should be treated early and aggressively to prevent late complications. Patients may have late deformity because of a failure of diagnosis, inadequate decompression, or a delay in fasciotomies. Late reconstruction will allow a plantigrade and relatively functional foot. Complete excision of scarred muscle will prevent recurrence in established deformities. Early treatment may prevent significant functional impairment by well-placed tenotomies. In patients with severe long-term deformities with extensive soft tissue contraction, incremental correction may be an appropriate intermediate intervention. Acute compartment syndrome of the limb 摘要: In this review the aetiology, clinical signs, diagnosis and therapy of the acute compartment syndrome of the limb is discussed. It is a limb- and untreated life threatening emergency. For good results, early detection is necessary. It is important to educate those taking care of patients of risk, especially in the early symptoms and signs. In uncooperative, unconscious and sedated patients pressure monitoring is recommended. The critical level of the absolute intracompartmental pressure is unclear. It is recommended to use a delta p pressure of 30 mm Hg. Below this pressure in the presence of clinical signs a fasciotomy of all compartments is the treatment of choice. (C) 2004 Elsevier Ltd. All rights reserved. 5 Diagnosing acute compartment syndrome Review: Acute compartment syndrome of the foot Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. The purpose of this article is to summarize and review the existing literature on this entity. Long-term sequelae of foot compartment syndrome (FCS) include contractures, deformity, weakness, paralysis, and sensory neuropathy. These complications are poorly tolerated, and often necessitate multiple procedures for rehabilitation. Therefore, the threshold for considering compartment syndrome and performing fasciotomy must be low to minimize such outcomes. The existence of nine foot compartments and frequent presence of complicating injuries necessitate multi-stick needle catheterization for direct measurement of compartment pressures. Fasciotomy is indicated when compartment pressure exceeds 30 mmHg, or if compartment pressure is greater than 10-30 mmHg below diastolic pressure. The approaches for compartment decompression generally include two dorsal incisions for access to forefoot compartments, and one medial incision for decompression of the calcaneal, medial, superficial, and lateral compartments. Acute compartment syndromes 摘要: Background: Acute compartment syndrome is both a limb- and life-threatening emergency that requires prompt treatment. To avoid a delay in diagnosis requires vigilance and, if necessary, intracompartmental pressure measurement. This review encompasses both limb and abdominal compartment syndrome, including aetiology, diagnosis, treatment and outcome. Methods: A Pubmed and Cochrane database search was performed. Other articles were cross-referenced. Results and conclusion: Diagnosis of limb compartment syndrome is based on clinical vigilance and repeated examination. Many techniques exist for tissue pressure measurement but they are indicated only in doubtful cases, the unconscious or obtunded patient, and children. However, monitoring of pressure has no harmful effect and may allow early fasciotomy, although the intracompartmental pressure threshold for such an undertaking is still unclear. Abdominal compartment syndrome requires measurement of intra-abdominal pressure because clinical diagnosis is difficult. Treatment is by abdominal decompression and secondary closure. Both types of compartment syndrome require prompt treatment to avoid significant sequelae. 6