骨筋膜室综合症修改后课件

骨筋膜室骨筋膜室综合症修改合症修改后后骨筋膜室综合症修改后骨筋膜室综合症修改后骨筋膜室综合症修改后1What is compartment syndrome?What is compartment syndrome?2COMPARTMENTS3Definition:An increased pressure within enclosed osteofascial space that reduces capillary per-fusion below level necessary for tissue Viability lead to ischemia and necrosis Definition:4DemographicsIncidence: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:5EtiologyFractures-closed and opensoft tissue injury without fxTemp vascular occlusionCast/dressingClosure of fascial defectsBurns/electricalSurgical positioningEtiologyFractures-closed and o6Pathophysiology:Pathophysiology:7Compartment SyndromeTissue SurvivalMuscle 3-4 hours-reversible changes6 hours-variable damage8 hours-irreversible changesNerve 0.5hours-Nerve dysfunction12-24 hours-irreversible changesCompartment SyndromeTissue Su8CLINICAL 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 affectedCLINICAL PRESENTATIONPnt c/o s9DiagnosisHistoryClinical exam:the PsCompartment pressuresLaboratory testsCPKUrine myoglobinDiagnosisHistory10Clinical DiagnosisThe six Ps:PressurePainParesthesiaParalysisPallorPulselessnessClinical DiagnosisThe six Ps11swellingswelling12PressureEarly findingOnly objective finding to Confirm clinical examTechniqueWhiteside infusionWick catheterSlit catheterPressureEarly finding13Whiteside TechniqueWhiteside Technique14骨筋膜室综合症修改后课件15骨筋膜室综合症修改后课件16骨筋膜室综合症修改后课件17Treatment 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 pressureTreatment Orthopae18Fasciotomy PrinciplesMake early diagnosisLong extensile incisions to Release all fascial compartmentsPreserve neurovascular structuresDebride necrotic tissuesCoverage within 7-10 daysFasciotomy PrinciplesMake earl19ForearmForearm20Leg AnatomyLeg Anatomy21Leg Single Incision TechniqueLeg Single Incision Technique22Leg Two Incision TechniqueLeg Two Incision Technique23Hand CompartmentsHand Compartments24Wound 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 swelling is minimalUsually requires skin graft Goal is to obtain definitive coverage within 7-10 daysWound CareSoft tissue coverage25谢谢！26谢谢！谢谢！27