小腿骨筋膜间隔综合征的诊治与延误分析  

Analysis of early and delayed diagnosis and treatment for osteofascial compartment syndrome of the lower leg

作　　者：麦汉溪[1] 段贤斌[1] 肖德明[1] 林博文[1] 

机构地区：[1]暨南大学第二临床医学院,深圳市人民医院骨科,深圳518020

出　　处：《中华创伤杂志》2005年第8期578-581,共4页Chinese Journal of Trauma

摘　　要：目的探讨小腿骨筋膜间隔综合征的成因、鉴别特征、早期诊治方法,并分析诊治延误原因。方法本组男41例,女22例;年龄7～58岁,平均35岁。其中闭合性骨折44例,开放性骨折11例,单纯软组织挫伤8例。致伤原因:交通伤38例,机械绞窄伤9例,高处坠落伤7例,辗压伤5例,砸伤4例。伤后1h～8d入院。18例因各种原因导致延误诊治,其中伤后14例8～12h,4例转入院时已超过24h。密切观察临床症状和特征,及时应用Whiteside针刺测压装置监测,多普勒超声血流探测仪或彩超检查。确诊后即时切开减压33例,保守治疗后减压30例。结果及时减压组优良率约91%(30/33),保守后减压组优良率约47%(14/30)(χ2=11.79,P<0.01)。随访10个月～10年,平均3年,其中1例后期形成慢性窦道骨髓炎,1例骨不连接再次植骨加内固定而治愈,6例截肢后安装义肢,足下垂、轻度膝、踝关节僵硬7例,站立及行走乏力4例;44例血液循环及下肢功能恢复良好。结论早期诊断、严密观察、及时切开减压是治疗骨筋膜间隔综合征的重要措施。Objective To explore the causes, diagnostic characteristics, earlier diagnosis and treatment of osteofascial compartment syndrome and analyze the reason for delayed diagnosis and treatment. Methods There were 41 males and 22 females with age range of 7-58 （ mean 35 years ） , of which 44 cases with closed fractures, 11 with open fractures and eight with only soft tissue contusion. Of all, 38 cases were resulted from traffic accidents, nine from mechanic twisting, seven from fall from height, five from crush and four from smash. All the cases were admitted into hospital with time ranging from one hour to eight days. But 18 cases resulted in delayed diagnosis and treatment due to various causes, with 14 cases admitted after 8-12 hours and four over 24 hours. The clinical symptoms and characteristics were closely observed by using Whiteside method and checked by Dopple hypersound and color hypersound. On a verified diagnosis, 30 were treated with decompression posterior to conservative treatment and 33 cases with prompt open decompression. Results Of 63 cases, 33 cases treated with open decompression were cured immediately, with excellence rate of 91% （30/33） , and 30 treated with open decompression after conservative treatment obtained excellence rate of 47% （14/30） （ X^2 = 11.79, P 〈0.01 ）. The follow up ranged from 10 months to 10 years （mean three years） showed that chronic myelitis of the sinus tract was seen in one case at late stage, bone ununion cured with regrafting plus internal fixation in one, artificial limbs used after amputation in six, Dropfoot and slight ankylosis of knees and ankle appeared in seven and inertia of standing and walking in four. Forty-four cases won satisfactory recovery of blood circulation and lower extremity function. Conclusion Early diagnosis, close observation and open decompression are important for treatment of osteofascial compartment syndrome.

关 键 词：小腿骨筋膜间隔综合征 治疗 诊断 闭合性骨折 开放性骨折 

分 类 号：R658[医药卫生—外科学]