跟骨骨折合并肌筋膜间室综合征的诊断与治疗

The diagnosis and treatment of compartment syndromes after calcaneal fractures

目的探讨跟骨骨折合并足部肌筋膜间室综合征的诊断及治疗方法。10月～1999年6月,利用Whiteside法测压装置对98例跟骨骨折患者进行足部肌筋膜间室内压力监测。其中9例间室内平均压力达46mmHg30～55mmHg),均经足后内侧入路进行足部肌筋膜间室切开减压术。术后继续监测全足各筋膜间室内压力,1例足部严重碾压伤者,术后跖骨间肌筋膜间室内压力仍为40mmHg,故再次行前足背侧入路减压。9例患者术后1周以刃厚皮片覆盖伤口口愈合经外侧入路行跟骨骨折切开复位内固定术。结果9例患者平均随访2年行走或站立过久时足跟及踝部有轻度疼痛,其中1例两点辨别觉、痛觉略有减退。无一例出现前足僵硬、爪形趾、软组织萎缩及运动功能异常。结论肌筋膜间室压力测定是诊断跟骨骨折合并足部肌筋膜间室综合征惟一可靠的方法,治疗方案以足后内侧切口进行减压疗效较好。

Objective To explore the diagnosis and treatment of compartment syndromes of the foot after calcaneal fractures. Methods Between October 1994 and June 1999, the intracompartmental pressures of foot were measured with the Whitesides method for 98 patients with calcaneal fractures. The interstitial pressures in 9 patients averaged 46 mmHg (range from 30 to 55 mmHg). All of the 9 patients were treated by fasciotomy through a hindfoot medial incision, then each intracompartment pressure were measured,respectively. An interosseous compartment pressure still was 40 mmHg. The patient whose foot had a severe crushing injury had fasciotomy of his interosseous compartment through two dorsal forefoot incisions. After a week, the wounds were covered with a split thinkness skin graft. The calcaneal fractures were treated with open reduction and internal fixation at 2 weeks after fasciotomy through a lateral incision. Results All of the 9 patients were followed up for a mean of 2 years (range from 18 to 35 months) after injury. Two patients had occasional hindfoot and ankle pain after walking or standing for a long time. One of them decreased pin stick sensation and two point discrimination. None of the cases developed stiffness of the forefoot or claw toes, nor soft tissue contracture and motor deficit. Conclusion It should not be neglected that the compartment syndromes of the foot may occur after calcaneal fractures. Intracompartment pressure measurements should be performed to confirm the diagnosis. Fasciotomy, which could be performed through a medial hindfoot incision, is the optimal way of treatment.