急性前臂筋膜室综合征预后不良的相关因素

The Hand Pub Date : 2019-11-05 DOI:10.1177/1558944719884662
Dafang Zhang, S. Janssen, Matthew A. Tarabochia, A. V. von Keudell, Brandon E. Earp, N. Chen, P. Blazar
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引用次数: 6

摘要

背景:关于急性前臂筋膜室综合征患者风险分层的文献有限。本研究的主要目的是确定急性前臂筋膜室综合征患者预后不良的相关因素。方法:回顾性分析2000年1月至2015年6月在2个一级创伤中心接受筋膜切开术治疗的130例前臂急性筋膜室综合征患者。不良预后被定义为一个复合变量,包括:(1)死亡;(2)截肢;(3)持续性神经功能缺损;(4)挛缩。收集患者和治疗相关变量。双变量分析用于筛选与不良结果相关的变量,P < 0.05的解释变量被纳入我们的多变量逻辑回归分析。结果:在130例急性前臂筋膜室综合征患者中,43例(33%)预后不佳,包括5例死亡,5例截肢,21例持续神经功能缺损,31例挛缩。多变量logistic回归分析显示,急性前臂筋膜间室综合征患者发病时血清肌酸激酶升高(P < 0.05)与预后不良相关。受试者工作特征曲线分析显示,血清肌酸激酶临界值为300 U/L时敏感性为92%,血清肌酸激酶临界值为10000 U/L时特异性为95%。结论:肌酸激酶水平高于300u /L是急性前臂筋膜室综合征高危患者的有效筛查试验。高于10,000 U/L的水平可能在知情同意和有关期望的咨询中发挥作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Factors Associated With Poor Outcomes in Acute Forearm Compartment Syndrome
Background: There is limited literature on risk stratification of patients with acute forearm compartment syndrome. The primary objective of this study was to identify factors associated with poor outcomes in patients with acute forearm compartment syndrome. Methods: We retrospectively identified 130 patients with acute compartment syndrome of 130 forearms treated with fasciotomies from January 2000 to June 2015 at 2 Level 1 trauma centers. Poor outcome was defined as a composite variable, including: (1) death; (2) limb amputation; (3) persistent neurological deficit; and (4) contracture. Patient- and treatment-related variables were collected. Bivariate analyses were used to screen for variables associated with poor outcome, and explanatory variables with a value of P < .05 were included in our multivariable logistic regression analyses. Results: Of the 130 patients, 43 (33%) with acute forearm compartment syndrome had poor outcomes, including 5 deaths, 5 limb amputations, 21 persistent neurological deficits, and 31 contractures. Multivariable logistic regression analyses showed that elevated serum creatine kinase at presentation (P < .05) was associated with poor outcomes in patients with acute forearm compartment syndrome. Receiver operating characteristic curve analysis showed that a serum creatine kinase cutoff of 300 U/L yields 92% sensitivity and a serum creatine kinase cutoff of 10 000 U/L yields 95% specificity for poor outcomes in acute forearm compartment syndrome. Conclusions: Elevated creatine kinase levels above 300 U/L are a useful screening test for the highest risk patients with acute forearm compartment syndrome. Levels above 10 000 U/L may play a role in informed consent and counseling regarding expectations.
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