骨筋膜室综合症修改后课件.ppt

Acute Compartment Syndrome（骨筋膜室综合症）,What is compartment syndrome?,COMPARTMENTS,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 7.3/100,000Women0.7/100,00069%due to trauma36%fx tibia9.8%distal radius23%soft tissue injury without fxHigh energy=low energy incidence,Etiology,Fractures-closed and opensoft tissue injury without fxTemp vascular occlusionCast/dressingClosure of fascial defectsBurns/electricalSurgical positioning,Pathophysiology:,Compartment SyndromeTissue Survival,Muscle 3-4 hours-reversible changes6 hours-variable damage8 hours-irreversible changesNerve 0.5hours-Nerve dysfunction12-24 hours-irreversible changes,CLINICAL PRESENTATION,Pnt c/o severe pain out of proportion to injuryPain aggravated by passive muscle stretchLoss（dysfunction）of sensation may be useful signDorsalis pedis pulse may or may not be affected,Diagnosis,HistoryClinical exam:the PsCompartment pressuresLaboratory testsCPKUrine myoglobin,Clinical Diagnosis,The six Ps:PressurePainParesthesiaParalysisPallorPulselessness,swelling,Pressure,Early findingOnly objective finding to Confirm clinical examTechniqueWhiteside infusionWick catheterSlit catheter,Whiteside Technique,Treatment,Orthopaedic Emergency!Lower leg to level of the heart(practical orthopedic P323lift the wounded limbs?)Remove castSplit all dressings down to skinFasciotomy if continued clinical findings and/or elevated compartment pressure,Fasciotomy Principles,Make early diagnosisLong extensile incisions to Release all fascial compartmentsPreserve neurovascular structuresDebride necrotic tissuesCoverage 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 daysSecond look debridement with consideration for coverage after 48-72 hrsLimb should not be at risk for further swellingPt should be adequately stabilized DPC(Delayed primary closure)possible if residual swelling is minimalUsually requires skin graft Goal is to obtain definitive coverage within 7-10 days,谢谢！,