足筋膜间隔综合征的定位诊断及治疗

The exact positional diagnosis and treatment of foot compartment syndromes

目的 探讨足筋膜间隔综合征的定位诊断及治疗效果。 方法 1994年 10月～1999年 6月 ,对 192例足损伤患者采用Whiteside法测压装置监测足部各筋膜间隔内压。 17例患者间隔内压 >30mmHg(1mmHg =0 .133kPa) ,其中骨间间隔 2例 ,内侧间隔 3例 ,外侧间隔 1例 ,跟部间隔 4例 ,跟部间隔伴骨间间隔 1例 ,跟部间隔伴内侧间隔 4例 ,涉及 3个以上间隔 2例。确诊后切开各压力升高的筋膜间隔 ,骨间间隔取足背纵切口 ,单纯内或外侧间隔取前足内或外侧切口 ,涉及跟部间隔均经足后内侧入路进行切开减压术。 1周后刃厚皮片覆盖伤口 ,对跗跖关节骨折脱位在减压同时进行复位内固定。跟骨骨折待创口愈合后经外侧入路行切开复位内固定术。 结果 17例患者平均随访 2年 (18～ 35个月 ) ,其中 3例行走时足或踝部疼痛 ,1例前足增宽、足弓较健侧减小 ,2例两点辨别觉、痛觉减退。无一例出现前足僵硬、爪形趾、软组织萎缩及运动功能障碍。 结论 足部损伤后 ,足筋膜间隔综合征不容忽视 ,各间隔内压监测是定位诊断的惟一可靠方法 ,根据定位诊断有针对性地减压各间隔 ,减小了不必要的损伤 。

Objective To explore the exact positional diagnosis and treatment of foot compartment syndromes. Methods Between October 1994 and June 1999, interstitial pressure of injured feet of 192 patients was measured with Whiteside's method. The foot interstitial pressure in 17 patients was more than 30 mm Hg. Two patients suffered from interosseous compartment syndromes, 3 patients from medical compartment syndromes, one from lateral compartment syndromes and 4 from calcaneal compartment syndromes. Four patients were associated with both calcaneal and medical compartment syndromes. One patient suffered from calcaneal and interosseous compartment syndromes. The pressure of three compartments was more than 30 mm Hg at the same time in 2 patients. According to the exact positional diagnosis, fasciotomy was performed on every compartment where interstitial pressure was more than 30 mm Hg through hindfoot medical, forefoot medical or dorsal forefoot incisions. After a week, the wounds were covered with a split thickness skin graft. For the fracture dislocations of the tarsometatarsal joint reduction and internal fixation and fasciotomy were performed at the same time. When the wound healed up the calcaneal fractures were treated with open reduction and internal fixation through a lateral incision. Results Seventeen patients were followed up for 18 35 months (mean= 2 years). Three patients suffered foot or ankle pain when walking. The forefoot width increased and the arch of the foot decreased in 1 patient. Two patients decreased pin stick sensation and two point discrimination. No patients were found to have stiffness of the forefoot, claw toes, soft tissue contracture or motor deficit. Conclusions The foot compartment syndromes after foot injury should be given much attention. Measurement of every intracompartment pressure should be determined to confirm the exact positional diagnosis. Fasciotomy should be performed for every compartment where the pressure is more than 30 mm Hg according to the precise diagnosis, which can decrease unnecessary trauma, and a good or excellent functional recovery of foot can be obtained.