Fascial compartment syndrome
Introduction
Introduction to fascial compartment syndrome The compartmental syndrome (compartmentyndrome, CS) is a progressive lesion that occurs in the specific fascial space of the extremities after limb trauma, that is, the pressure increases due to the increase of the interstitial contents, and the interstitial contents are mainly muscle and nerve trunk. Progressive ischemic necrosis. The fascial space syndrome can occur when the volume of the fascial space is increased, the pressure is increased, or the volume of the fascial septum is reduced, and the volume of the contents is relatively increased. basic knowledge The proportion of illness: 0.01%-0.03% Susceptible people: no special people Mode of infection: non-infectious Complications: acute renal failure
Cause
Cause of fascial compartment syndrome
(1) Causes of the disease
Limb crush injury (30%):
The limb is bruised by heavy objects, crushed or heavy objects are pressed for a long time. For example, when an earthquake collapses, the building collapses on the limbs, drunk, CO poisoning, etc. The limbs of the comatose are pressed under their own trunks or limbs, under pressure. Tissue ischemia, after the pressure is removed, the blood is reperfused, so that the injured tissue is mainly muscle tissue hemorrhage, reactive swelling, so that the volume of the contents of the spacer increases, and the pressure increases.
Limb vascular injury (25%):
Major vascular injury of the limbs, ischemia of the muscles and other tissues supported by the limbs for more than 4 hours. After repairing the blood vessels to restore blood flow, the muscles and other tissues are reactively swollen, causing the contents of the interstitial to increase and the pressure to increase, and the disease occurs, such as the femoral artery or Brachial artery injury, repair of blood vessels after 4h, may occur in the calf compartment syndrome, limb trauma bleeding, in the first aid, the tourniquet time is longer, such as 2 ~ 3h, the limb has not been necrotic, after removal of the tourniquet, limb reactivity In cases of severe swelling, calf compartment syndrome may occur in the lower extremities, supracondylar fracture of the humerus, compression at the fracture site, stimulation or injury to the brachial artery, resulting in stasis or blood stasis, resulting in forearm muscle ischemia, Volkmann contracture, also tendon A type of membrane gap syndrome.
Internal bleeding in limb fractures (15%):
Limb fracture, bleeding into the fascial space, because the complete structure of the fascial space has not been destroyed, the blood can not overflow and the volume of the contents increased, so that the pressure increased and the incidence, can be seen in the ankle fracture and forearm fracture.
Improper fixing of plaster or splint (15%):
Many literature reports that the external splint or plaster splint is fixed. Because the over-tightening pressure is too large, the fascial gap volume is compressed, the tissue is damaged, and the swelling is also increased. If the splint is not relaxed in time, the eigengen can occur. See the forearm or calf fracture.
Lumbar muscle bleeding (5%):
Due to trauma or hemophilia bleeding, limited by muscle sheath, hemorrhage swelling, increased pressure, hip deformity, can compress the femoral nerve to the quadriceps paralysis.
Other (10%):
During the operation of the lithotomy position, the two calves were placed on the bracket, and the triceps of the calf were compressed for more than 5 hours, which also caused the intrinsic symptoms. Five cases were reported by the Macintosh. Postoperative calf fascial compartment syndrome, forearm and hand infusion Exudation can also cause fascial compartment syndrome.
(two) pathogenesis
When the limb is crushed or other causes, the muscles in the fascial space are hemorrhagic and swollen, and the volume of the interstitial contents is increased. Due to the constraint of the fascia tube, the muscle can not be expanded to the periphery, and the pressure in the gap is increased. The increase of pressure increases the resistance of lymphatic and venous return in the interstitial space, and the venous pressure increases, which in turn increases the pressure inside the capillaries, thereby increasing the exudation, increasing the volume of the contents of the spacer, and further increasing the internal pressure of the interstices. Vicious circle, that is, the content increases the internal pressure rises the venous pressure rises the capillary pressure rises the exudation increases the content increases, under normal circumstances, the pressure in the interval increases, not even greater than the internal artery of the gap Dry systolic blood pressure, thus reducing the arterial blood flow at the distal end through the interval, but not interrupted, the distal pulse of the limb is weakened and even unclear, but the end has blood transport and not necrosis, due to the internal pressure of the gap Increased can make the capillary of the tissue in the area closed, the microcirculation is blocked, the tissue perfusion is reduced, necrosis due to ischemia, hypoxia, and the permeability of capillaries in hypoxia , Increased bleeding, a vicious cycle, the outer surface of the spacer body skin, may be swollen blisters, due to adjacent blood supply, generally necrosis does not occur, but the nerve function (skin feel) loss due to reduced blood flow.
Prevention
Fascia compartment syndrome prevention
Early diagnosis is extremely important, lack of experience in clinical performance or incomplete understanding of the disease, confusion of unreliable clinical signs, and delay in diagnosis leading to serious consequences. Therefore, the search for an effective diagnostic method and the use of appropriate surgical methods are the key to preventing its severity.
Complication
Fascia septal syndrome complications Complications acute renal failure
The main complications of the fascial compartment syndrome are:
1 fascia cut wound infection.
2 combined with acute renal failure, such complications in the case of simple compartment syndrome syndrome are not many.
3 ischemic contracture.
Symptom
Symptoms of fascial compartment syndrome Common symptoms Acute pain, muscle contracture, flexion of the wrist, weakness, calf or forearm gap syndrome, severe pain, weakness, paralysis
Symptom
Pain and activity disorder are the main symptoms. After the limb injury, the pain is generally complained. However, in the early stage of the compartmental space syndrome, the pain is progressive. The limb is not relieved by limb fixation or treatment, and the muscle is ischemic. The pain is aggravated until the muscles are completely necrotic, the pain continues to increase without remission, and the muscle activity is swollen and the active activity is impaired.
2. Signs
Swelling, tenderness and passive muscle pulling pain are important signs of this disease. Limb swelling is the earliest sign. In the forearm, calf, etc., due to the tough fascia wrap, the swelling is not serious, but the skin swelling is obvious, often Blisters, obvious tenderness at the muscle abdomen is an important sign of muscle ischemia in the fascial space, passively pulling the muscle at the end of the limb, such as the forearm volar fascial space syndrome, passively stretching the straight finger, causing the flexion Severe pain in the muscles.
Examine
Examination of fascial compartment syndrome
Early white blood cells are normal, and later the condition is aggravated, and there may be elevated white blood cells.
Pressure measurement
The intra-tissue pressure measurement can show that the pressure in the intermuscular space can rise from normal zero to 1.33 to 2.66 kPa (10-20 mmHg) or even 3.99 kPa (30 mmHg). This pressure indicates that the decompression needs to be cut early, otherwise it is possible There is an irreversible change (normal pressure is below 10mmHg).
2. Other
MR and neurophysiological examinations are also helpful in judging and should be differentiated from calf arteries and nerve injuries. Of course, in some cases, they constitute one of the pathogenic factors and can affect each other to form a cycle of evil. .
Diagnosis
Diagnosis and differentiation of fascial compartment syndrome
Note that the clinical manifestations of calf arterial injury are as follows:
1. The dorsal artery pulsation weakens or disappears: a common symptom of calf arterial injury, the anterior tibial artery is blocked, the dorsal artery of the foot disappears, and the other two arteries are affected. The reflex of the limb can also cause paralysis of the anterior tibial artery. And the weakness or disappearance of the dorsal artery pulsation occurs.
2. Prone to calf muscle compartment syndrome: In addition to violent factors, sputum and obstruction after arterial injury not only directly cause ischemic changes of muscles and nerve branches, but also exacerbate the high pressure state in the muscle interval, so the calf muscle compartment syndrome The incidence is clearly high, and the two can form a vicious circle of each other.
