Compartment syndrome CS (CS) is a progressive lesion that occurs in specific fascial compartments of the extremities after limb trauma, i.e., progressive ischemic necrosis of the compartment contents, mainly the muscles and nerve trunks, due to the increase in the compartment contents and pressure. In recent years, chronic trigger or exertional gap syndrome has also emerged.
Etiology: Fascial interstitial syndrome can occur whenever the volume of the fascial interstitial contents can increase, the pressure can increase or the volume of the fascial interstitial area can decrease, resulting in a relative increase in the volume of its contents.
It is commonly seen in.
1, crush injuries to the limb.
2. Vascular injuries to the limb. This is especially important to note, the main vascular injury of the limb, muscle tissue ischemia in more than 4 hours, after repairing the blood vessels to restore blood flow, the tissue will occur reactive swelling, so that the interstitial content increases, the pressure increases, and the syndrome occurs.
3. Internal bleeding of limb fracture. The fracture of the limb, bleeding into the fascial space, because the intact structure of the fascial space is not damaged, the accumulated blood can not overflow and the volume of the contents increases, making the pressure increase and the onset of the disease, seen in tibial fractures and forearm fractures.
4.Improper fixation of plaster or splint.
5.Iliopsoas muscle bleeding. Due to muscle sheath restriction, hemorrhage and swelling, increased pressure, flexion hip deformity, may compress the femoral nerve causing quadriceps paralysis.
6.Chronic exertional compartment sydrome
) is mostly seen in sports and exercise people, especially in long-distance running and other lower limb exercise people, can occur. It is mainly seen in the deep posterior compartment, posterior compartment and anterior compartment of the lower leg. Due to long time exercise, the metabolites of the lower leg muscles increase, resulting in chronic increase of pressure in the compartment, and the symptoms occur gradually.
Clinical manifestations: The onset of fascial gap syndrome is generally rapid, and in severe cases, typical symptoms and signs can be developed in about 24 hours.
1. Pain, which is progressively worse, until the muscle is completely necrotic before it is aggravated and not relieved. Swelling, pain and passive muscle pulling pain are important signs of the disease.
Swelling is often the earliest sign when patients visit the clinic, and blister formation is seen when swelling is significant.
2. Sensory impairment. The terminal color of the limb is mostly normal, but the pulse is often diminished or not palpable.
3, Late manifestations are mainly brought about by limb contracture deformity and nerve trunk injury.
Diagnosis: The clinical diagnosis is the word “early”, early judgment and preventive incision is necessary and essential, the consequences of fascial gap syndrome is very serious, and the treatment effect, the only way to avoid such consequences is early diagnosis and early treatment. If treated promptly and with the correct measures, the muscles within the fascial gap are spared from necrosis and nerve function is not compromised, but fully recovered.
The timing of surgical fascial decompression is critical to the prognosis. Early decompression within 24 hours of incision is associated with complete recovery and normal function, except in cases where the nerve itself is damaged.
In cases with late incision, the prognosis varies depending on the time of incision. 36h incision, the deep muscles of forearm and forearm are not yet necrotic, and the hand function can still be restored to normal after surgery. 3 to 8 days incision, most of the deep muscles are necrotic, but the superficial muscles are still good, and mild ischemic contracture deformity can be left after surgery. 18 days and 3 months post-injury incision cases, there is no improvement on muscle ischemic contracture.
Treatment methods.
1, non-surgical treatment.
The use of mannitol is effective, and those with fascial gap pressure below 30 mmHg can be treated by braking, elevating the affected limb, and observing closely for 7 to 10 days, with the swelling subsiding and symptoms disappearing, which can be completely cured without leaving any sequelae. Because of the rapid development of the disease, the consequences are serious, for the treatment, it is better to lose the incision too early than to lose with delay.
2.Surgical treatment.
In this case, the patient had a typical history of injury, the patient had obvious swelling of the limb, severe pain of passive muscle pulling, with nerve dysfunction, as well as proximal ulna fracture and penetrating injury.
The surgery was performed in two stages.
The first stage was incision and reduction to repair the damaged muscle tissue.