■肢体截肢是急性骨筋膜室综合征的可能结果。我们进行了这项研究,以调查安大略省成人胫骨骨折患者筋膜切开术和截肢的发生情况。旨在评估可能与每个结果相关的变量。
■回顾性,基于人群的队列研究(2003年4月1日-2016年3月31日)。
■加拿大安大略省。
■胫骨骨折患者,14岁及以上。
■胫骨骨折后筋膜切开术。
■主要结果是筋膜切开术后1年内的筋膜切开术和截肢。次要结果包括重复手术,新发肾功能衰竭,和死亡率,全部在筋膜切开术后30天内。
■我们确定了76,299例胫骨骨折患者;平均(SD)年龄为47(21)岁。在1303例患者中进行了筋膜切开术(1.7%);其中,76%为男性,24%为女性。年轻的病人,男性,或经历过的多发性创伤明显更有可能进行筋膜切开术。接受筋膜切开术的患者中有4.3%发生截肢,与没有筋膜切开术的人相比,这一比例为0.5%;年龄较大,男性,多发性创伤的存在,筋膜切开术与截肢风险增加相关(年龄比值比[OR]为1.03[95%CI,1.02-1.03],P<0.0001;性别OR为2.04[95%CI,1.63-2.55],P<0.0001;多发性创伤OR为9.37[95%CI,7.64-11.50],P<0.0001;筋膜切开术OR为4.35[95%CI,3.21-5.90],P<0.0001),以及30天内重复手术(性别OR为1.54[95%CI,1.14-2.07],P=0.0053;多发性创伤OR为4.24[95%CI,3.33-5.38],P<0.0001)。
■在胫骨骨折患者中,男性和多外伤患者接受筋膜切开术和随后截肢的风险明显较高.筋膜切开术也与截肢风险显著相关,这一发现可能反映了最初损伤的严重程度。
UNASSIGNED: Limb amputation is a possible outcome of acute compartment syndrome. We undertook this
study to investigate the occurrence of
fasciotomy and amputation in patients with tibial fractures in the Ontario adult population, aiming to evaluate variables that may be associated with each of these outcomes.
UNASSIGNED: Retrospective, population-based cohort
study (April 1, 2003-March 31, 2016).
UNASSIGNED: Canadian province of Ontario.
UNASSIGNED: Patients with tibial fracture, aged 14 years and older.
UNASSIGNED: Fasciotomy after tibial fracture.
UNASSIGNED: The primary outcomes were
fasciotomy and amputation within 1 year of
fasciotomy. Secondary outcomes included repeat surgery, new-onset renal failure, and mortality, all within 30 days of fasciotomy.
UNASSIGNED: We identified 76,299 patients with tibial fracture; the mean (SD) age was 47 (21) years. Fasciotomy was performed in 1303 patients (1.7%); of these, 76% were male and 24% female. Patients who were younger, male, or experienced polytrauma were significantly more likely to undergo fasciotomy. Limb amputation occurred in 4.3% of patients undergoing fasciotomy, as compared with 0.5% in those without
fasciotomy; older age, male sex, presence of polytrauma, and
fasciotomy were associated with an increased risk of amputation (age odds ratio [OR] of 1.03 [95% CI, 1.02-1.03], P < 0.0001; sex OR of 2.04 [95% CI, 1.63-2.55], P < 0.0001; polytrauma OR of 9.37 [95% CI, 7.64-11.50], P < 0.0001; fasciotomy OR of 4.35 [95% CI, 3.21-5.90], P < 0.0001), as well as repeat surgery within 30 days (sex OR of 1.54 [95% CI, 1.14-2.07], P = 0.0053; polytrauma OR of 4.24 [95% CI, 3.33-5.38], P < 0.0001).
UNASSIGNED: Among tibial fracture patients, those who were male and who experienced polytrauma were at significantly higher risk of undergoing fasciotomy and subsequent amputation. Fasciotomy was also significantly associated with risk of amputation, a finding that is likely reflective of the severity of the initial injury.