研究骨筋膜室综合征的早期治疗及后期畸形矫正。

北京积水潭医院烧伤科2008年1月至2012年12月期间共收治46例骨筋膜室综合征患者，其中8例损伤严重，后期遗留严重的后遗症。对此8例患者病例资料、手术处理及最后的功能恢复进行回顾性研究。

8例患者中7例存在不同程度的骨折。所有患者均有不同程度的神经损伤，4例合并血管损伤。小腿肌肉坏死：涉及前、外侧肌群6例，2例患者除腓肠肌存活外，所有肌肉坏死。6例患者于外伤后12～24 h进行筋膜切开减张术，1例于2 d后行减张术，另1例未行减张。患者入院后经过2～4次的清创术，坏死组织去除彻底，3例行伤口间断缝合，5例行植皮＋缝合后创面愈合。所有患者均出现不同程度的后遗症。2例患者第5跖骨基底出现神经性溃疡，经创面换药愈合。4例患者出现爪状趾畸形，经肌腱延长和关节成形术矫正。所有患者均出现马蹄足畸形，通过Ilizarov外架牵拉恢复到中立位，6例逐步过渡到正常负重行走；2例患者马蹄足畸形严重，经Ilizarov外架牵拉、踝关节融合得到永久矫正。

骨筋膜室综合征可造成肌肉、神经缺血坏死并导致严重的后遗症。早期应该在全身情况稳定的前提下进行创面清创以促进创面愈合，后期严重的马蹄足畸形需要通过对骨及软组织处理才能得到永久的功能恢复。创面清创、Ilizarov外架牵拉、踝关节融合是严重骨筋膜室综合征序贯治疗重要的手段。骨筋膜室综合征最好的治疗是预防，足踝畸形治疗也是一样。

To study the early wound treatment and the late sequelae correction of the patient with lower extremity compartment syndrome.

All of 46 patients, with lower limb compartment syndrome and were performed fasciotomy in other hospital, were admitted to Beijing Jishuitan hospital between January 2008 and December 2012. Eight patients who had severe sequelae at late stage were included this study. A retrospective study was carried out on the 8 patients, the medical and surgical date and functional recovery information were investigated.

Among the 8 cases, 7 cases had different degrees of fracture. All patients had different degrees of nerve injury, and 4 cases had vascular injury. Muscle necrosis involving the anterior and lateral muscle groups in 6 cases, involving the anterior, lateral and posterior deep muscle groups (except for gastrocnemius muscle survival) in 2 cases. Fasciotomy were performed 12-24 hours after injury in 6 cases, and 2 days in 1 cases, the other one cases was treated at the stage of septic necrosis of the muscles involved six months after injury. Necrotic tissue was removed completely after 2-4 times debridement and wound healed with suture in 3 cases, and with skin grafting and suture in 5 cases. All patients had different degrees of sequelae. Neuropathic ulceration occurred at the fifth metatarsal head and healed after wound dressing in 2 cases. Clawed toes and hallux deformity were presented in 4 cases, and the clawed toes were corrected through resection arthroplasty of proximal interphalangeal point (PIP) joints, the clawed hallux were treated by flexor halluces longus tendon lengthening and resection arthroplasty of the first metatarsophalangeal joint. Equinovarus deformity were happened in all the patients and ankle joint achieved 0°dorsiflexion through the application of Ilizarov fixator, 6 cases were gradually returned to normal weight bearing walking without the use of aid, a tibio talar arthrodesis was performed and the ankle joint acquired permanently corrected in 2 cases.

The lower extremity compartment syndrome can cause muscle and nerve ischemia necrosis and lead to serious sequelae. In the early stage, wound debridement should be performed in order to promote wound healing on the basis of the stability of the whole body. Wound debridement, Ilizarov fixator application, and arthrodesis were important methods for the sequential treatment of severe compartment syndrome. However, the best treatment for compartment syndrome was prevention, so did the late sequelae.