Long-term physical outcome of patients who suffered crush syndrome after the 1995 Hanshin-Awaji earthquake: Prognostic indicators in retrospect
Long-term physical outcome of patients who suffered crush syndrome after the 1995 Hanshin-Awaji earthquake: Prognostic indicators in retrospect
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DOI：
10.1097/00005373-200201000-00008
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发表时间：
2002-01-01
影响因子：
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通讯作者：
Yokota, J
中科院分区：
文献类型：
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作者：
Matsuoka, T;Yoshioka, T;Yokota, J
背景：1995年阪神-Awaji地震后发生的372例挤压综合征提供了一个独特的机会来调查这些患者的长期身体结局并建立特定治疗的适应证。本研究的目的是找出挤压综合征患者身体预后的独立预测因素，并阐明筋膜切开术对预后的影响。方法：对42例患者在地震2年后进行感觉和运动功能检查，共58条患肢受压。用逐步回归分析评价抢救时间、筋膜切开时间、清创时间对小腿肌力的影响。结果：接受筋膜切开术的患者中，47%(8/17)的患者存在与小腿筋膜室相关的严重残疾，而未接受筋膜切开术的患者中，有16%(4/25)的患者存在与小腿筋膜室相关的严重残疾。前室损伤较后室严重。接受筋膜切开术治疗的前室和后室的严重感觉和运动障碍的发生率高于未接受筋膜切开术的患者。逐步回归分析显示，筋膜切开/清理术评分是小腿肌力的独立预测因子(R=0.67，p<；0.0001)，当不包括清理室时，抢救时间是独立的预测因子(R=0.36，p=0.009)。在所有清创的前室中，肌肉的收缩能力完全丧失。筋膜切开时间与小腿肌力呈显著负相关。结论：继发性筋膜室综合征影响挤压综合征患者的身体预后。我们没有证据表明筋膜切开术可以改善预后。延迟抢救、延迟筋膜切开术和根治性清创可能会使身体预后恶化。挤压综合征急性期筋膜切开术的适应证需要进一步商议。
Background: The 372 cases of crush syndrome that followed the 1995 Hanshin-Awaji earthquake have provided a unique opportunity to investigate the long-term physical outcomes and to establish indications for specific treatments in such patients. The objectives of this study were to identify independent predictors of physical outcome in patients suffering from crush syndrome and to clarify the influence of fasciotomy on outcomes.Methods: Sensory and motor functions were examined 2 years after the earthquake in 42 patients with a total of 58 compressed lower extremities. The influences of time to rescue, fasciotomy, and radical debridement on lower leg muscle strength were evaluated by stepwise regression analysis. Correlation between the time to fasciotomy and lower leg muscle strength was also analyzed.Results: Severe disabilities related to the lower leg compartment were present in 47% (8/17) of patients who underwent fasciotomy and in 16% (4/25) of patients who did not. The anterior compartment was damaged more severely than the posterior compartment. Severe sensory and motor disturbances occurred at a higher rate in relation to anterior and posterior compartments that were treated by fasciotomy than in relation to those that were not. Stepwise regression analysis showed fasciotomy/debridement score to be an independent predictor of long-term lower leg muscle strength (R = 0.67, p < 0.0001) and showed time to rescue to be an independent predictor when debrided compartments were not included in the analysis (R = 0.36, p = 0.009). In all debrided anterior compartments, muscle contractility was completely abolished. There was a significant negative correlation between time to fasciotomy and lower leg muscle strength.Conclusion: Secondary compartment syndrome affects physical outcome in crush syndrome patients. We obtained no evidence that fasciotomy improves outcome. Delayed rescue, delayed fasciotomy, and radical debridement may worsen the physical prognosis. Indications for fasciotomy in crush syndrome during the acute phase need further deliberation.