树上坠落造成多处损伤引起的室间隔综合征的治疗策略:病例报告。

IF 2 Q2 EMERGENCY MEDICINE International Journal of Emergency Medicine Pub Date : 2024-07-15 DOI:10.1186/s12245-024-00675-5
Tomotaka Miura, Takahito Miyake, Hideshi Okada, Hideaki Oiwa, Yosuke Mizuno, Yuichiro Kitagawa, Tetsuya Fukuta, Haruka Okamoto, Masato Shiba, Norihide Kanda, Takahiro Yoshida, Shozo Yoshida, Shinji Ogura
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引用次数: 0

摘要

背景:室间隔综合征常见于前臂和小腿骨折患者。臀部和大腿肌肉的室间隔综合征则不太常见。当务之急是尽快诊断并通过筋膜切开术治疗筋膜室综合征。然而,对于同时发生在多个解剖区域或同侧臀部和大腿的室间隔综合征,有关其诊断和治疗策略的报道却很少:我们报告了一名 76 岁的男性,他被斜压在一棵从右前臂延伸至左腹股沟的树下。他被送到我们的急诊室,被诊断为右前臂和左小腿室间隔综合征以及挤压综合征。急诊科为他进行了筋膜切开术。入院第二天,左臀部大腿明显肿胀和紧绷,椎间隙内压力升高,因此又被诊断为这些椎间隙综合征。患者接受了筋膜切开术,按照Kocher-Langenbeck入路(髋部骨折后入路之一)切开臀部皮肤,并将切口向外侧延伸至大腿。这种手术方法只需一个切口,就能对椎间隙进行减压,伤口处理和闭合也更容易:本病例突出了四个解剖区域的隔室综合征的诊断和治疗。将Kocher-Langenbeck方法扩展到大腿外侧是治疗同侧臀部和大腿筋膜室综合征的有效手术方法。
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Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report.

Background: Compartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compartment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome be diagnosed and treated with fasciotomy as soon as possible. However, there are few reports on the diagnosis and treatment strategies for compartment syndromes that occur simultaneously in multiple anatomical regions or in the ipsilateral gluteal region and thigh.

Case presentation: We report on a 76-year-old man who was obliquely crushed under a tree extending from the right forearm to the left groin. He was brought to our emergency room, where he was diagnosed with compartment syndrome of the right forearm and left lower leg and crush syndrome. Emergency fasciotomy was performed. On the day after admission, swelling and tightness of the left gluteal thigh became apparent, and intracompartmental pressures were elevated, which led to an additional diagnosis of these compartment syndromes. A fasciotomy was performed, the gluteal skin incision was made according to the Kocher-Langenbeck approach (one of the posterior approaches for hip fractures), and the thigh was approached by extending the incision laterally. This surgical approach enabled the decompression of the compartments through a single incision and allowed for easier wound treatment and closure.

Conclusion: This case highlights the diagnosis and treatment of compartment syndrome in four anatomical regions. Extension of the Kocher-Langenbeck approach to the lateral thigh can be a useful surgical approach for ipsilateral gluteal and thigh compartment syndrome.

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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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