早期诊断和治疗塌方所致骨筋膜室综合征20例

Early diagnosis and treatment of compartment syndrome caused by landslides:a report of 20 cases

目的:总结20例煤矿事故中塌方所致骨筋膜室综合征患者早期诊断和治疗的方法,以提高救治骨筋膜室综合征的诊治水平,减少伤残。方法:自2006年9月至2010年4月采用早期切开减压、全身综合支持和处理治疗骨筋膜室综合征20例,均为男性,年龄23～54岁,平均42岁。所有术前患肢高张力肿胀、剧痛,被动牵拉痛阳性,5例肢端感觉减退或消失,远端血管搏动正常、减弱或消失,5例有肌红蛋白尿、高血钾、血清尿素氮和肌酐升高,1例少尿。对疗效予以统计并对患肢功能进行伤残等级评定。结果:20例患者,并发患肢感染3例,肾功能损害6例。治愈16例,基本治愈3例,截肢1例。20例患者均获随访,时间6～15个月,平均12个月。根据劳动能力鉴定——职工工伤与职业病致残等级分级(GB/T16180-2006)评定,5级伤残1例,8级伤残2例,10级伤残1例,无等级伤残16例。结论:骨筋膜室综合征的早期发现不能简单地以足背动脉搏动减弱或消失为依据,早期诊断、早期切开减压、全身综合支持和处理是减少伤残的关键。

Objective：To summarize early diagnosis and treatment methods of 20 patients with compartment syndrome caused by landslides during coal mine accidents in order to improve the level of diagnosis and treatment of compartment syndrome and reduce disability. Methods：From September 2006 to April 2010,20 patients with compartment syndrome were treated with the methods of early decompression,systemic support. All the patients were male with an average age of 42 years（ranged,23 to 54）. All the patients with high tension limb swelling,pain,referred pain passive positive;5 extremities feeling diminish or disappear and the distal blood vessel beat were normal or weakened or disappeared;myoglobinuria,hyperkalemia,serum urea nitrogen and creatinine increased in 5 cases and oliguria in occurred 1 case. The function of affected limbs was observed according to disability ratings. Results：Three cases complicated with infection of affected limb and 6 cases occurred with renal function insufficiency. Total recovery was in 16 cases,basically recovery in 3,amputation in 1 case. All patients were followed up for 6-15 months with an average of 12 months. The ability to work according to national standard identification——Employee work-related injuries and occupational disability rating classification （GB/T16180-2006） to assess,grade 5 was in 1 case,grade 8 in 2 cases,grade 10 in 1 case,no grade in 16 cases. Conclusion：Arteriopalmus of dorsalis pedis weaken and vanished can not be regard as an evidence in early diagnosis of compartment syndrome. Early diagnosis and decompression,systemic support and treatment is the key in reducing disability.