Compartment syndromes l 1912 Wilson first described the

什麼是腔室症候群? (Compartment syndromes)

腔室症候群 l 1912: Wilson first described the exertional compartment syndrome. l 1956: Mavor reported a case of chronic compartment syndrome. l 14% of leg pain with anterior compartment syndrome (Qvarfordt et al). l 1 -9% of leg fractures with compartment syndrome.

成因 l Decreased compartment size ¡ Constrictive ¡ Closure dressing and casts. of fascial defects. ¡ Thermal injuries and frostbite. l Increased compartment contents ¡ Increased ¡ Trauma, capillary permeability fracture, contusion ¡ Postischemic swelling: lying on a limb

成因 l Burns l Orthopaedic procedures: osteotomy, fracture fixation l Intensive use of muscles: seizures, tetany, eclampsia l Intraarterial l Snakebite drugs

成因 l Increased capillary pressure l Venous obstruction l Exercise l Vascular injury l Bleeding disorder, anticoagulant therapy l Muscle hypertrophy l Nephrotic syndrome l Popliteal cyst

腔室的位置 l Upper arm ¡ Anterior compartment ¡ Posterior compartment l Forearm ¡ Volar compartment ¡ Dorsal compartment

腔室的位置 l Hand ¡ Thenar and hypothenar compartment ¡ Interosseous ¡ Lower extremity ¡ Gluteal ¡ Thigh compartment

腔室的位置 l Leg ¡ Anterior ¡ Lateral compartment ¡ Superficial ¡ Deep posterior compartment

How long can tissues tolerate the increased compartmental pressure? l Whitesides et al noted: 50 mm Hg的壓力可承受 4 -8 小時 40 mm Hg的壓力可承受 6 小時 即出現早期神經肌肉的傷害 l Gelberman et al noted: 在正中神經施於 50 mm Hg 的壓力， 4小時即出現 感覺及運動的異常

臨床症狀 典型的症狀為 5 P： l Pain l Pallor l Paresthesia l Pulseless l Paralysis

症狀的總結: “ 7 P” l Pain disproportionate to the primary diagnosis. l Pain worsened by passive stretch of the affected muscles. l Pressure palpable over the compartment.

症狀的總結: “ 7 P” l Paresis of affected muscles. l Paresthesias in the distribution of affected nerves. l Pallor. l Pulselessness in the most severe cases.

Measurement of compartment pressures l Infusion ¡ Needle ¡ Too l Wick Technique (Whitesides) in the most pain or tense location much saline: false high readings Catheter Technique (Mubarak) l Continuous Monitoring Technique (Matsen) l 每個人有不同的臨界值 l 會因血壓的變動有所變動

Pressure Threshold for Fasciotomy l 正常的密閉腔室壓力約為 0 -8 mm. Hg。 l 15 -20 mm. Hg 組織的血流將會不足，且發 生缺氧之狀況。 l Matsen: 45 mm. Hg l Whitesides: l Mubarak l 30 -40 diastolic BP – 20 mm. Hg and Hargens: 30 mm. Hg for emergent fasciotomy

Method of Skin Incision

Method of Skin Incision