腔室症候群.pptVIP

腔室症候群 什麼是腔室症候群?(Compartment syndromes) 腔室症候群 1912: Wilson first described the exertional compartment syndrome. 1956: Mavor reported a case of chronic compartment syndrome. 14% of leg pain with anterior compartment syndrome (Qvarfordt et al). 1-9% of leg fractures with compartment syndrome. 腔室症候群 極嚴重的臨床問題 惡性循環 組織受創?釋出發炎物質?微血管擴張且血管內膜之通透性上升?血漿向外滲至筋膜腔合併紅血球滯流腔室內?壓力上升?血液循環受阻?組織缺氧?釋放更多發炎物質 腔室症候群 當壓力上升至 50 mm Hg，血流量下降至70%；而壓力到達 80 mm Hg時，血流只剩下5% 。 有兩種分類： 外傷引起，如：骨折，肌肉挫傷。 日常生活引起 (microtrauma)，稱之為 exertional compartment syndrome 。 腔室症候群 悄悄地發生 (insidious onset) 在傷害後的數小時到數天均有可能 若不及時處理，則會造成肌肉壞死、以及二度感染、變縮變形、.神經缺損、壞疽、傷口不癒合以及骨折不癒合等等的合併症。 甚至於急性腎衰竭，休克，死亡。 成因 Decreased compartment size Constrictive dressing and casts. Closure of fascial defects. Thermal injuries and frostbite. Increased compartment contents Increased capillary permeability Trauma, fracture, contusion Postischemic swelling: lying on a limb 成因 Burns Orthopaedic procedures: osteotomy, fracture fixation Intensive use of muscles: seizures, tetany, eclampsia Intraarterial drugs Snakebite 成因 Increased capillary pressure Venous obstruction Exercise Vascular injury Bleeding disorder, anticoagulant therapy Muscle hypertrophy Nephrotic syndrome Popliteal cyst 腔室的位置 Upper arm Anterior compartment Posterior compartment Forearm Volar compartment Dorsal compartment 腔室的位置 Hand Thenar and hypothenar compartment Interosseous compartment Lower extremity Gluteal compartment Thigh compartment 腔室的位置 Leg Anterior compartment Lateral compartment Superficial posterior compartment Deep posterior compartment 組織可承受多久的壓力? How long can tissues tolerate the increased compartmental pressure? Whitesides et al noted: 50 mm Hg的壓力可承受 4-8 小時 40 mm Hg的壓力可承受 6 小時 即出現早期神經肌肉的傷害 Gelberman et al noted: 在正中神經施於 50 mm Hg 的壓力， 4小時即出現感覺及運動的異常 臨床症狀 典型的症狀為5P： Pain Pallor Paresthesia Pulseless Paralysis 疼痛(pain) 疼痛是最早且最重要的症狀，但並不是最可靠的症狀。 腔室症候群疼痛不同於骨折的疼痛，它是“深的、無法定位、持續地、且常無法用一般止痛劑止痛的”痛。 (out of proportion to the injury ) 當