骨筋膜室综合症修改后.ppt

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 necrosis Demographics Incidence: Men 7.3/100,000 Women 0.7/100,000 69% due to trauma 36% fx tibia 9.8% distal radius 23% soft tissue injury without fx High energy = low energy incidence Etiology Fractures-closed and open soft tissue injury without fx Temp vascular occlusion Cast/dressing Closure of fascial defects Burns/electrical Surgical positioning Pathophysiology: Compartment SyndromeTissue Survival Muscle 3-4 hours - reversible changes 6 hours - variable damage 8 hours - irreversible changes Nerve 0.5hours - Nerve dysfunction 12-24 hours - irreversible changes CLINICAL PRESENTATION Pnt c/o severe pain out of proportion to injury Pain aggravated by passive muscle stretch Loss（dysfunction） of sensation may be useful sign Dorsalis pedis pulse may or may not be affected Diagnosis History Clinical exam: the Ps Compartment pressures Laboratory tests CPK Urine myoglobin Clinical Diagnosis The six ‘Ps’: Pressure Pain Paresthesia Paralysis Pallor Pulselessness swelling Pressure Early finding Only objective finding to Confirm clinical exam Technique Whiteside infusion Wick catheter Slit catheter Whiteside Technique Treatment Orthopaedic Emergency! Lower leg to level of the heart(《 practical orthopedic 》P323lift the wounded limbs?) Remove cast Split all dressings down to skin Fasciotomy if continued clinical findings and/or elevated compartment pressure Fasciotomy Principles Make early diagnosis Long extensile incisions to Release all fascial compartments Preserve neurovascular structures Debride necrotic tissues Coverage within 7-10 days Forearm Leg Anatomy Leg Single Incision Technique Leg Two Incision Technique Hand Compartments Wound Care Soft tissue coverage with a bulky compression dressing by 5-7 days