病例报告:无痛室综合征

A. Shpigelman, D. Maman, Fadi Khalil Hanna, Jeries Hakim, Dimitri Vodovozov, B. Bernfeld
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引用次数: 0

摘要

简介:急性筋膜室综合征(ACS)是一种外科急诊,需要紧急干预,以防止永久性结构损伤和不可逆的功能残疾。ACS的诊断依赖于高怀疑指数,依赖于以下通常被称为5p的诊断标准;疼痛,感觉异常,麻痹,苍白,无脉搏。当诊断不确定时,室内压大于30mmhg提示ACS。病例介绍:我们报告一例未确诊的ACS,缺乏典型的表现在一个37岁的男性患者,有肌病史。患者因右髋关节直接创伤而被送进急诊室,没有明显的视觉模拟评分。髋关节x线片显示右股骨转子下骨折。在手术中发现了另一例隐蔽性同侧肱骨下骨折。术中根据大腿的临床表现及术中临床表现对ACS进行诊断。行筋膜切开术,经股骨近端钉切开复位内固定。后来,活检结果证实了ACS的诊断。结论:本病例提示肌病可以掩盖ACS的典型表现。此外,在这方面不能依赖疼痛主诉的程度和伴随的感觉异常,为了诊断ACS,应考虑其他临床特征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Case Report: Painless Compartment Syndrome
Introduction: Acute compartment syndrome (ACS) is a surgical emergency that requires urgent intervention in order to prevent permanent structural damage and irreversible functional disability. The diagnosis of ACS depends on a high index of suspicion, relying on the following diagnostic criteria commonly known as the 5 Ps; Pain, Paresthesia, Paralysis, Pallor, and Pulse-lessness. When the diagnosis is uncertain, intracompartmental pressure greater than 30 mmHg is suggestive of ACS. Case Presentation: We report a case of an underdiagnosed ACS, with a lack of classical presentation in a thirty-seven-years-old male patient with a history of myopathy. The patient was admitted to the emergency room due to direct trauma to his right hip, without a significant Visual Analogue Score. On his hip radiograph a subtrochanteric fracture of the right femur was demonstrated. An additional masked ipsilateral subcapital fracture was detected during the operation. The diagnosis of ACS was made during the operation while relying on the clinical appearance of the thigh and the clinical findings during surgery. Fasciotomies were performed, and open reduction with internal fixation via Proximal Femoral Nail was done. The diagnosis of ACS was confirmed later on, by the biopsy results. Conclusion: This case suggests that myopathy can mask the classical presentation of ACS. Furthermore, the extent of pain complaints and accompanying paresthesia cannot be relied on in this regard and other clinical features should be considered in order to diagnose ACS.
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