肌肉清创治疗上肢急性期筋膜室间隔综合征的疗效

Treatment outcomes of muscle debridement in acute upper limb compartment syndrome

目的 探索急性期筋膜室间隔综合征患者肌肉清创的手术方法并评估术后疗效.方法 回顾性分析自2005年6月至2013年3月不同原因引起的急性期筋膜室间隔综合征患者13例,全部在筋膜减张的同时行肌肉内坏死组织清创及神经肌肉松解.结果 12例患者直接闭合创面,1例在12 d后延迟闭合创面;11例在术后3周左右获得Ⅰ期愈合;术后3周内9例获得不同程度的运动及感觉功能改善;术后3个月以上5例患者获得随访,对运动和感觉功能恢复较满意.结论 肌肉清创作为筋膜减张术的补充,降低了肌肉内坏死部分所占的比例,使急性期患者创面直接闭合及Ⅰ期愈合的比例升高,并能通过早期功能锻炼,促进患肢近期和远期的功能康复.

Objective To introduce the procedures of muscle debridement in acute compartment syndromes and evaluate the surgical outcomes.Methods From June 2005 to March 2013,thirteen patients who sustained acute compartment syndrome underwent fasciotomy,extensive debridement of necrotic portion of the involved muscles as well as release of nerves and muscles in the meantime.Results Direct wound closure was possible in 12 patients.Delayed wound incision closure in 12 days was done in one patient.Primary wound healing was achieved in 11 patients around 3 weeks postoperatively.Nine patients obtained varied degrees of improvement in both motor and sensory functions.Five patients were follow-up for more than 3 months and they were rather satisfied with the muscle strength and sensory recovery.Conclusion In addition to fasciotomy,debridement of involved muscles can decrease the extent of muscle necrosis in acute compartment syndrome patients.It also increases the chance of direct wound closure and primary wound healing,facilitates early rehabilitation,and thus leads to much better short-term and long-term functional outcomes.