The Experiences of Management of Compartment Syndrome of Extremity

隔間症候群是指組織隔間內壓力過高，造成肌肉神經血液灌注不足，而形成缺血損傷狀態。隔間症候群臨床上典型的表現，包括：疼痛、感覺異常、麻痺、蒼白及無脈。一般而言，正常的組織隔間壓力不大於8毫米汞柱，假如壓力上升至30毫米汞柱以上，必須施行緊急筋膜切開術，以減低壓力。隔間症候群同時可能併發肌溶解症，甚至急性腎衰竭。因此在治療上要注意補充足夠的水份，並且密切注意腎功能的變化。如果有急性腎衰竭發生，可以考慮洗腎治療。至於筋膜切開的傷口照顧，應維持傷口無菌及防止組織乾燥，一至二週後予以裂層植皮手術覆蓋傷口。本文回顧台大醫院十年來32個病歷個案，依原因不同，分爲創傷性及非創傷性隔間症候群，比較兩組之性別、年齡、位置，及併發症，並列舉一特別案例的診斷與治療過程，總體而言，隔間症候群的癒後良好，併發症並不多見。

關鍵字

無資料

並列摘要

Compartment syndrome is a clinical state of myoneural anoxia caused by prolonged elevation of tissue pressure and lead to decreased nerve and muscle capillary perfusion and necrosis. Generally speaking, fasciotomy is indicated if intracompartment pressure is higher than 30 mmHg. This article reviews 32 patients of compartment syndrome of extremity at National Taiwan University Hospital in recent 10 years. Among which, 22 are contributed to the traumatic group and 10 of non-traumatic. Differences between these two groups are compared. Patients of the traumatic group are younger, male predominant, mostly involving the leg and have less complication. On the contrary, the patients of non-traumatic group are older with some medical or psychological problems, frequently involving the upper extremity and have higher complication rate. One special case of thigh compartment syndrome developed acute renal failure after standard treatment such as fasciotomy and hydration with NaHCO3 induction. Hemodialysis was done and the renal function recovered eventually. The majority of the 32 patients received STSG for fasciotomy wound coverage 10 to 14 days later and the healing was rather well. No related mortality was found; only one patient died of underlying disease. The infection rate of fasciotomy is low and easy to manage. Early diagnosis according to either clinical pictures (5p: pain, paresthesia, paralysis, pallor and pulselessness) or elevated intracompartment pressure, emergency fasciotomy, aggressive hydration, adequate wound care and general support are considered important in the management of compartment syndrome of extremity.

並列關鍵字

compartment syndrome ； fasciotomy ； acute renal failure

國際替代計量

The Experiences of Management of Compartment Syndrome of Extremity

全文下載

主題瀏覽