tailieunhanh - Hội chứng cấp tính ngăn Chấn thương

Tiến sĩ Olson là Phó Giáo sư, Khoa Phẫu thuật chỉnh hình, Đại học Duke, Durham, NC. Tiến sĩ Glasgow là Bác sĩ phẫu thuật chỉnh hình, Phòng Phẫu thuật chỉnh hình, Bệnh viện Hoàng gia Alexander, Edmonton, AB, Canada. Không ai trong số các tác giả sau đây hoặc các phòng ban mà họ là chi nhánh đã nhận được bất cứ thứ gì có giá trị từ hoặc sở hữu cổ phiếu | Acute Compartment Syndrome in Lower Extremity Musculoskeletal Trauma Steven A. Olson MD and Robert R. Glasgow MD Dr. Olson is Associate Professor Division of Orthopaedic Surgery Duke University Durham NC. Dr. Glasgow is Orthopaedic Surgeon Division of Orthopaedic Surgery Royal Alexander Hospital Edmonton AB Canada. None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article Dr. Olson and Dr. Glasgow. Reprint requests Dr. Olson Duke University Box 3389 Durham NC 27710. J Am Acad Orthop Surg 2005 13 436-444 Copyright 2005 by the American Academy of Orthopaedic Surgeons. Abstract Acute compartment syndrome is a potentially devastating condition in which the pressure within an osseofascial compartment rises to a level that decreases the perfusion gradient across tissue capillary beds leading to cellular anoxia muscle ischemia and death. A variety of injuries and medical conditions may initiate acute compartment syndrome including fractures contusions bleeding disorders burns trauma postischemic swelling and gunshot wounds. Diagnosis is primarily clinical supplemented by compartment pressure measurements. Certain anesthetic techniques such as nerve blocks and other forms of regional and epidural anesthesia reportedly contribute to a delay in diagnosis. Basic science data suggest that the ischemic threshold of normal muscle is reached when pressure within the compartment is elevated to 20 mm Hg below the diastolic pressure or 30 mm Hg below the mean arterial blood pressure. On diagnosis of impending or true compartment syndrome immediate measures must be taken. Complete fasciotomy of all compartments involved is required to reliably normalize compartment pressures and restore perfusion to the affected tissues. Recognizing compartment syndromes requires having and maintaining a high index of suspicion .