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1、AcuteCompartmentSyndrome(骨筋膜室綜合癥)Whatiscompartmentsyndrome?COMPARTMENTSDefinition:Anincreasedpressurewithinenclosedosteofascialspacethatreducescapillaryper-fusionbelowlevelnecessaryfortissueViabilityleadtoischemiaandnecrosisDemographicsIncidence:Men7.3/100
2、,000Women0.7/100,00069%duetotrauma36%fxtibia9.8%distalradius23%softtissueinjurywithoutfxHighenergy=lowenergyincidenceEtiologyFractures-closedandopensofttissueinjurywithoutfxTempvascularocclusionCast/dressingClosureoffascialdefectsBurns/electricalSurgicalpo
3、sitioningPathophysiology:CompartmentSyndromeTissueSurvivalMuscle3-4hours-reversiblechanges6hours-variabledamage8hours-irreversiblechangesNerve0.5hours-Nervedysfunction12-24hours-irreversiblechangesCLINICALPRESENTATIONPntc/oseverepainoutofproportiontoinjury
4、PainaggravatedbypassivemusclestretchLoss(dysfunction)ofsensationmaybeusefulsignDorsalispedispulsemayormaynotbeaffectedDiagnosisHistoryClinicalexam:thePsCompartmentpressuresLaboratorytestsCPKUrinemyoglobinClinicalDiagnosisThesix‘Ps’:PressurePainParesthesiaP
5、aralysisPallorPulselessnessswellingPressureEarlyfindingOnlyobjectivefindingtoConfirmclinicalexamTechniqueWhitesideinfusionWickcatheterSlitcatheterWhitesideTechniqueTreatmentOrthopaedicEmergency!Lowerlegtoleveloftheheart(《practicalorthopedic》P323liftthewoun
6、dedlimbs?)RemovecastSplitalldressingsdowntoskinFasciotomyifcontinuedclinicalfindingsand/orelevatedcompartmentpressureFasciotomyPrinciplesMakeearlydiagnosisLongextensileincisionstoReleaseallfascialcompartmentsPreserveneurovascularstructuresDebridenecroticti
7、ssuesCoveragewithin7-10daysForearmLegAnatomyLegSingleIncisionTechniqueLegTwoIncisionTechniqueHandCompartmentsWoundCareSofttissuecoveragewithabulkycompressiondressingby5-7daysSecondlookdebridementwithconsiderationforcoverageafter48-72hrsLimbshouldnotbeatris
8、kforfurtherswellingPtshouldbeadequatelystabilizedDPC(Delayedprimaryclosure)possibleifresidualswellingisminimalUsuallyrequiresskingraftGoalistoobtaindefinitivecoveragewithin7-10days謝謝!