儿童骨筋膜间隔综合征的手术切口选择

Selection of incision in the treatment of early osteofascial compartment syndrome

目的探讨大直切口和网状切口治疗儿童骨筋膜间隔综合征（osteofascial compartment syndrome，OCS）中的临床疗效。方法2000年1月-2009年5月共收治保守治疗无效的56例儿童OCS，部位主要是前臂、小腿。OCS患儿均早期行网状切口切开减压，合并骨折者I期复位骨折并行外支架固定或Ⅱ期切开复位固定。同期收治在外院已行大切口切开减压的OCS患儿21例（包括地震伤患儿13例），给予创面换药，经1～5周感染控制后直接缝合或植皮愈合创口，所有创面均进行细菌培养。合并骨折者均Ⅱ期切开复位固定。结果采用网状切口治疗的56例患儿切口均I期愈合，无感染，不需植皮，无感觉功能障碍等后遗症。在外院行大切口的21例患儿16例培养出细菌（地震伤13例），5例有神经损伤，包括桡神经2例和腓总神经3例，其中对4例神经被完全或部分切断患儿行神经吻合修复术，术后症状有好转。切口直接缝合9例，植皮愈合12例，切口平均约3周愈合。术后平均随访5．6年，参照中华医学会手外科学会手部功能评定试用标准，两组患儿无爪形手足畸形发生，总优良率分别约98％和95％。结论大切口和网状切口均可用于治疗儿童早期OCS，而网状切口更方便，操作简单，并发症少。

Objective To evaluate the clinical effect of long incision and reticular incision in the treatment of osteofascial compartment syndrome （OCS） in children. Methods The study involved 56 children with OCS who met failure of the conservative treatment. The injury sites included mainly the forearm and the leg. All the children underwent decompression by a small reticular incision procedure from January 2000 to May 2009. The fractures were treated with one stage reduction and fixation or second stage open reduction. Meanwhile, the study involved another 21 children （including 13 earthquake victims） who were treated with long incision for open decompression in the other hospitals before admission. All the wounds were healed by direct suture or dermatoplasty after 1-5 weeks of infection control. Bacterial culture was performed in all the wounds. The fractures were treated with secondary open reduction and fixation. Bacteria culture was done in all wounds. Results The reticular ineisional wounds of 56 patients were healed free from dermatoplasty, with no infection or sensory dysfunction. Among 21 patients treated with long incision, the bacteria culture was positive in 16 patients （including 13 earthquake victims） and verve injury found in five patients （ including two with radial nerve injury and three with peroneal nerve injury）. Four patients with partial or complete cut-off of the verves were improved after repair by seconda- ry operation. Direct suture of incisions was done in nine patients and skin graft performed in 12, with av- erage healing time for three weeks. The patients were followed up for mean 5.6 years, which showed no claw hands, with overall satisfactory rate for about 98% and 95% respectively in two groups according to the probation standard of amputated finger function evaluation from the Hand Surgery Plant of Chinese Medical Association. Conclusions Both long incision and reticular incision procedures can be used early in the treatment of pediatric OCS, while the reticular incision procedure is more convenient and sim- ple, with less complications.