compartment syndrome
Introduction
Introduction to compartment syndrome Osteofascial compartment syndrome (osteofascialcompartmentsyndrome) is a series of early symptoms and signs of acute muscle ischemia and hypoxia caused by bone, interosseous membrane, intermuscular septum and deep fascia. Also known as acute compartment syndrome, osteofascial compartment syndrome. The disease can be accompanied by serious complications and must be treated as soon as possible. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock
Cause
Cause of osteofascial compartment syndrome
Partial compression of the limb (45%):
(l) Dressing is too tight after trauma or surgery. (2) Severe local compression: The limb is subjected to long-term compression by foreign heavy objects or body weight. These conditions lead to further enhancement of capillary permeability due to acute ischemia and hypoxia, increased fluid exudation, severe tissue edema, and increased internal pressure to form a vicious circle.
Capillary lesions (40%):
(1) Tissue swelling after ischemia: the permeability of tissue ischemic capillaries is enhanced, fluid exudation, tissue edema, and volume increase. (2) Injury, contusion, crush injury, IIo~IIIo burns and other injuries cause increased capillary permeability, increased exudation, tissue edema, and increased volume. (3) The calf strenuous exercise, such as long-distance running, marching, etc., enhance capillary permeability. (4) Intra-osseous hemorrhage, hematoma squeezed other tissues.
Prevention
Osteofascial compartment syndrome prevention
There is no effective prevention method, and early detection is early. In the process of dressing injury and daily care of the body, special attention should be paid to avoid the ischemia induced by the corresponding tissue, and the inflammatory reaction and other diseases should be treated in time to prevent the capillary permeability from increasing, causing hemorrhage and edema, and inducing the compartment of the compartment. Change, leading to the disease.
Complication
Complications of compartment syndrome Complications
The wall of the compartment of the fascia is tough and inelastic. If the volume of the chamber is suddenly reduced or the volume of the chamber is suddenly increased, the pressure in the compartment of the fascia increases sharply, blocking the blood circulation in the room, and the muscles in the compartment of the fascia. Neural tissue ischemia. After ischemia of the muscle tissue, capillary permeability increases, a large amount of exudate enters the interstitial space, and edema is formed, which further increases the pressure in the periosteum, forming an ischemic-edema-ischemic vicious circle. If measures are not taken in time, the following consequences will occur:
1. Onset of ischemic muscle contracture: in the early stage of severe ischemia, after active rescue and timely recovery of blood supply, it can avoid or only a small amount of muscle necrosis, or affect the function of the affected limb, or minimal impact. .
2. Ischemic muscle contracture: short-term complete ischemia, or a heavier degree of incomplete ischemia. After actively recovering its blood supply, most of the muscle tissue is necrotic and can still be repaired by fibrous tissue, but The scar is contracted to form a unique deformity, and the claw-shaped hand and the claw-shaped foot will seriously affect the function of the affected limb.
3. Gangrene: Complete ischemia with a wide range and long time. The result is a large number of muscle gangrene, which cannot be repaired, and often requires amputation. A large amount of toxins into the blood can cause shock, arrhythmia and acute renal failure.
The above three results are three different stages of the compartment of the compartment or limb ischemia, which develop rapidly and deteriorate rapidly until gangrene.
Symptom
Symptoms of compartment syndrome Syndrome Common symptoms Blood pressure drop Pulse accelerates leukocytosis
The early clinical manifestations of compartment syndrome are mainly local. Systemic symptoms occur only when muscle ischemia is long and extensive necrosis has occurred. For example, elevated body temperature, increased pulse rate, decreased blood pressure, increased white blood cell count, accelerated erythrocyte sedimentation rate, and myosin in the urine.
1. Pain: Sustained severe pain in the limbs after trauma, and progressive progression, the earliest symptoms of the sign. It is an important manifestation of nerve compression and ischemia in the periosteum. The nerve tissue is most sensitive to ischemia, and the sensory fiber has the earliest symptoms. It must be paid enough attention to it and diagnosed and treated in time. In the advanced stage, when the ischemia is severe and the nerve function is lost, the feeling disappears, that is, there is no pain.
2. The finger or toe is in a flexed state and the muscle strength is weakened. Passive stretching of the fingers or toes can cause severe pain and is an early manifestation of muscle ischemia.
3. The surface of the affected room is slightly red, the temperature is slightly higher, the swelling is swollen, and there is severe tenderness. The palpation can feel the increase of the indoor tension.
4. The distal pulse and capillary filling time are normal. However, special attention should be paid to the increase of intra-osseous tissue pressure to a certain extent: forearm 8.66 kPa (65 mmHg) and calf 7.33 kPa (55 mmHg), which can close the small artery supplying muscle blood, but this pressure is much lower than the patient. The systolic blood pressure is therefore insufficient to affect the blood flow of the main arteries of the limb. At this time, although the distal arterial pulsation exists, the filling time of the finger and toe capillaries is still normal, but the muscle has already developed ischemia. Therefore, the presence of the distal arterial pulse of the limb is not a safe indicator, and should be observed and analyzed in combination with other clinical manifestations. Assist in diagnosis.
The above symptoms and signs are not fixed. If left untreated, ischemia will continue to worsen, developing ischemic muscle contractures and gangrene, and symptoms and signs will change. The five main clinical manifestations of ischemic contracture can be recorded as five "P" words:
(1) It changes from pain to painless.
(2) pale (pallor) or hairpin, marble pattern, etc.
(3) Paresthesia.
(4) Paralysis.
(5) Pulselessness.
Examine
Examination of osteofascial compartment syndrome
Increased body temperature, increased pulse rate, decreased blood pressure, increased white blood cell count, accelerated erythrocyte sedimentation rate, and myosin in the urine.
According to the results of clinical observations, the examinations after the pressure rise in each fascial compartment are as follows:
Forearm spacer
(1) Local tissue tension occurs on the dorsal side, there is tenderness, and when the thumb and the extension of the flexor digitorus are unable to passively flex the thumb and fingers, it causes pain.
(2) Tissue tension occurs on the volar side, tenderness on the volar side of the forearm, weakness of the thumb and flexor digitorum, and passive thumb extension cause loss of skin sensation of painful ulnar nerve and median nerve distribution.
2. Each leg of the interval
(1) There are extensor digitorum extensor muscles and deep peroneal nerves in the anterior compartment. When the pressure in the interval rises, in addition to tissue tension and tenderness on the anterior side of the calf (sometimes redness and swelling), there may be a loss of skin sensation in the deep branch of the radial nerve, weakness in the toe muscle and tibialis anterior muscle, and pain caused by passive flexion.
(2) There are superficial nerves of the iliac muscle group in the lateral compartment. When the gap is compressed, the skin cannot disappear and the skin feels disappeared. Pain caused by varus in the foot, local skin tension and tenderness are manifested in the lateral tibia of the calf, but it is rare in clinical pressure in this gap. When the above signs appear, the common peroneal nerve injury should be considered first.
(3) There is a soleus muscle and gastrocnemius muscle in the posterior compartment of the calf. This pressure is more common in the femoral artery, vein or agitation, vein injury and only repair the artery. The signs are manifestations of tonic clubfoot deformity, which causes pain in the muscles when the dorsiflexion is performed, and swelling and tenderness behind the calf.
(4) There are flexor digitorum muscles, posterior muscles, and posterior tibial nerves in the middle compartment. When the gap is compressed, the flexor digitorum and the posterior tibial muscle are weak, and when the toe is stretched, the pain is distributed and the skin distribution of the nerve is distributed. On the inside of the distal end of the calf, the tissue between the Achilles tendon and the tibia is tense and tender. Patients with fascial compartment syndrome may have elevated body temperature, and increased white blood cell count may also increase erythrocyte sedimentation rate, but it does not necessarily indicate that the patient has an infection. The fascial compartment syndrome is a developmental disorder that may not be obvious when it occurs. In case of suspicious circumstances, it should be closely observed and checked for early diagnosis and timely treatment.
Diagnosis
Diagnosis and differentiation of compartment syndrome
Diagnosis is based on clinical performance and examination.
(1) Excluding arterial injury and peripheral nerve injury: The results of both compartment syndrome and arterial injury are ischemia, and the clinical manifestations have many similarities, so sometimes there will be confusion and misdiagnosis in judgment. To analyze and summarize their clinical characteristics, an instrumental examination is needed to make a diagnosis. There are several cases of arterial injury: rupture, thrombosis, spasm, and compression by the surrounding tissue (incompleteness) to reduce the flow, etc., should pay attention to identification. Osteofascial compartment syndrome can make the arterial pulsation weak or not obvious. At this time, don't mistake the arterial injury, the two can affect each other. If the peripheral nerve injury is combined, the pain performance is not obvious. At this time, other indications must be considered.
(2) The ischemia of the muscle tissue of the forearm or calf should be distinguished from or related to the ischemic manifestations of the hand and foot: in general, the compartment syndrome does not completely block the blood supply to the aorta, at most Weakened, so there is no complete ischemic manifestation in the hand and foot or only a certain degree of blood supply is weakened. The ischemic condition of the forearm or calf cannot be completely determined by the ischemic condition of the hand and foot; the muscle tissue of the forearm or calf is deficient. After the blood, it will manifest as a sensory disturbance of the hand and foot, so the ischemia of the forearm or calf can be inferred from the change in the sense of movement of the hand and foot.
(3) Osteofascial compartment syndrome and crush syndrome are two concepts, to be clearly defined.
