骨筋膜室綜合癥修改后課件

1、骨筋膜室綜合癥修改后骨筋膜室綜合癥修改后骨筋膜室綜合癥修改后What is compartment syndrome?骨筋膜室綜合癥修改后骨筋膜室綜合癥修改后骨筋膜室綜合癥修改后What is compartment syndrome?What is compartment syndrome?COMPARTMENTSCOMPARTMENTSDefinition:An increased pressure within enclosed osteofascial space that reduces capillary per-fusion below level necessary for t

2、issue Viability lead to ischemia and necrosis Definition:DemographicsIncidence:Men 7.3/100,000Women0.7/100,00069% due to trauma36% fx tibia9.8% distal radius23% soft tissue injury without fxHigh energy = low energy incidenceDemographicsIncidence:EtiologyFractures-closed and opensoft tissue injury wi

3、thout fxTemp vascular occlusionCast/dressingClosure of fascial defectsBurns/electricalSurgical positioningEtiologyFractures-closed and oPathophysiology:Pathophysiology:Compartment SyndromeTissue SurvivalMuscle 3-4 hours - reversible changes6 hours - variable damage8 hours - irreversible changesNerve

4、 0.5hours - Nerve dysfunction12-24 hours - irreversible changesCompartment SyndromeTissue SuCLINICAL PRESENTATIONPnt 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 affectedCLI

5、NICAL PRESENTATIONPnt c/o sDiagnosisHistoryClinical exam:the PsCompartment pressuresLaboratory testsCPKUrine myoglobinDiagnosisHistoryClinical DiagnosisThe six Ps:PressurePainParesthesiaParalysisPallorPulselessnessClinical DiagnosisThe six PsswellingswellingPressureEarly findingOnly objective findin

6、g to Confirm clinical examTechniqueWhiteside infusionWick catheterSlit catheterPressureEarly findingWhiteside TechniqueWhiteside Technique骨筋膜室綜合癥修改后課件骨筋膜室綜合癥修改后課件骨筋膜室綜合癥修改后課件Treatment Orthopaedic Emergency!Lower leg to level of the heart( practical orthopedic P323lift the wounded limbs?)Remove castS

7、plit all dressings down to skinFasciotomy if continued clinical findings and/or elevated compartment pressureTreatment OrthopaeFasciotomy PrinciplesMake early diagnosisLong extensile incisions to Release all fascial compartmentsPreserve neurovascular structuresDebride necrotic tissuesCoverage within

8、 7-10 daysFasciotomy PrinciplesMake earlForearmForearmLeg AnatomyLeg AnatomyLeg Single Incision TechniqueLeg Single Incision TechniqueLeg Two Incision TechniqueLeg Two Incision TechniqueHand CompartmentsHand CompartmentsWound CareSoft 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 swelli