中华手外科杂志
中華手外科雜誌
중화수외과잡지
CHINESE JOURNAL OF HAND SURGERY
2012年
5期
294-296
,共3页
儿童%筋膜间隔综合征%治疗结果
兒童%觔膜間隔綜閤徵%治療結果
인동%근막간격종합정%치료결과
Child%Compartment syndromes%Treatment outcome
目的 对儿童前臂筋膜室间隔综合征不同时期治疗结果进行分析.方法 回顾性分析2008年10月至2010年3月天津医院小儿骨科收治的14例前臂筋膜室间隔综合征住院患儿的病史、诊断、治疗和结果.根据临床表现分为早期:受伤后24h内就诊且得到治疗,未出现前臂缺血性肌挛缩(10例)；晚期:受伤后超过24h就诊,经过治疗残留不同程度的前臂缺血性肌挛缩或截肢(2例)；后遗症期:来院就诊时已出现不可逆的前臂缺血性肌挛缩(2例).结果 儿童前臂筋膜室间隔综合征最常见的骨折是孟氏骨折7例,其次是完全移位的肱骨髁上骨折4例,移位大的尺、桡骨骨折3例.早期10例行前臂筋膜切开减张术,预后良好.晚期2例行前臂筋膜切开减张术,1例出现前臂缺血性肌挛缩,1例截肢.后遗症期2例,1例行肌腱转移使腕部功能改善但畸形仍存,1例尺桡骨成角畸形合并前臂缺血性肌挛缩,只行切开复位内固定,术中发现前臂骨骼肌肉均被纤维组织代替失去功能,前臂已无好的动力肌腱作为转移肌腱改善前臂功能.结论 儿童前臂筋膜室间隔综合征早期诊断,及时行前臂筋膜切开减张术可完全阻止前臂缺血性肌挛缩发生,预后好.延误诊断和治疗可造成严重的与肌肉坏死程度相关的病变,晚期肌肉纤维化和神经功能缺陷可终身致残.
目的 對兒童前臂觔膜室間隔綜閤徵不同時期治療結果進行分析.方法 迴顧性分析2008年10月至2010年3月天津醫院小兒骨科收治的14例前臂觔膜室間隔綜閤徵住院患兒的病史、診斷、治療和結果.根據臨床錶現分為早期:受傷後24h內就診且得到治療,未齣現前臂缺血性肌攣縮(10例)；晚期:受傷後超過24h就診,經過治療殘留不同程度的前臂缺血性肌攣縮或截肢(2例)；後遺癥期:來院就診時已齣現不可逆的前臂缺血性肌攣縮(2例).結果 兒童前臂觔膜室間隔綜閤徵最常見的骨摺是孟氏骨摺7例,其次是完全移位的肱骨髁上骨摺4例,移位大的呎、橈骨骨摺3例.早期10例行前臂觔膜切開減張術,預後良好.晚期2例行前臂觔膜切開減張術,1例齣現前臂缺血性肌攣縮,1例截肢.後遺癥期2例,1例行肌腱轉移使腕部功能改善但畸形仍存,1例呎橈骨成角畸形閤併前臂缺血性肌攣縮,隻行切開複位內固定,術中髮現前臂骨骼肌肉均被纖維組織代替失去功能,前臂已無好的動力肌腱作為轉移肌腱改善前臂功能.結論 兒童前臂觔膜室間隔綜閤徵早期診斷,及時行前臂觔膜切開減張術可完全阻止前臂缺血性肌攣縮髮生,預後好.延誤診斷和治療可造成嚴重的與肌肉壞死程度相關的病變,晚期肌肉纖維化和神經功能缺陷可終身緻殘.
목적 대인동전비근막실간격종합정불동시기치료결과진행분석.방법 회고성분석2008년10월지2010년3월천진의원소인골과수치적14례전비근막실간격종합정주원환인적병사、진단、치료화결과.근거림상표현분위조기:수상후24h내취진차득도치료,미출현전비결혈성기련축(10례)；만기:수상후초과24h취진,경과치료잔류불동정도적전비결혈성기련축혹절지(2례)；후유증기:래원취진시이출현불가역적전비결혈성기련축(2례).결과 인동전비근막실간격종합정최상견적골절시맹씨골절7례,기차시완전이위적굉골과상골절4례,이위대적척、뇨골골절3례.조기10례행전비근막절개감장술,예후량호.만기2례행전비근막절개감장술,1례출현전비결혈성기련축,1례절지.후유증기2례,1례행기건전이사완부공능개선단기형잉존,1례척뇨골성각기형합병전비결혈성기련축,지행절개복위내고정,술중발현전비골격기육균피섬유조직대체실거공능,전비이무호적동력기건작위전이기건개선전비공능.결론 인동전비근막실간격종합정조기진단,급시행전비근막절개감장술가완전조지전비결혈성기련축발생,예후호.연오진단화치료가조성엄중적여기육배사정도상관적병변,만기기육섬유화화신경공능결함가종신치잔.
Objective To analysis the results of treating pediatric forearm compartment syndrome at different periods.Methods The clinical (history,diagnosis,treatment and results) and radiographic records of 14 children with forearm compartment syndrome hospitalized from October 2008 to March 2010 were reviewed.According to the clinical manifestations,this syndrome was divided into three types.Early type:treatment occurred within 24 hours of injury and no Volkmann's ischemic contractttre was found (10 cases).Late type:treatment was beyond 24 hours after the injury and varying degrees of Volkmann's ischemic contracture or amputation occurred (2 cases).Sequelae type:irreversible forearm Volkmann's ischemic contracture already existed upon presentation (2 cases).Results Monteggia fracture was the most common fracture seen in this series (7 cases),followed by supracondylar fracture of the humerus with complete displacement (4 cases),and the double fractures of the forearm (3 cases).Fasciactomy and decompression in 10 cases of the early type led to good prognosis,with restoration of normal activities of the forearm.In late type,even with fasciactomy,one case developed Volkmann's ischemic contracture and one case had amputation.In sequelae type,wrist function improved after tendon transfer but deformity remained in one case.The other case had malunion of both ulna and radius and Volkmann's ischemic contracture.During open reduction and internal fixation,fibrosis tissues were seen to have completely replaced muscles of the forearm.No tendon transfer could be performed to improve forearm function.Conclusion Early diagnosis and treatment of forearm compartment syndrome in pediatric patients are very important for good prognosis.Timely fasciactomy is the only effective method to prevent nerve and muscle necrosis.Failure to identify compartment syndrome early may lead to permanent loss of limb function.
