Intramuscular and blood pressures in legs positioned in the hemilithotomy position - Clarification of risk factors for well-leg acute compartment syndrome
Intramuscular and blood pressures in legs positioned in the hemilithotomy position - Clarification of risk factors for well-leg acute compartment syndrome
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DOI：
10.2106/00004623-200210000-00014
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发表时间：
2002-10-01
影响因子：
5.3
通讯作者：
Hargens, AR
中科院分区：
文献类型：
--
作者：
Meyer, RS;White, KK;Hargens, AR
背景：在普通外科、泌尿科和妇科的长时间手术中，急性间隔室综合征广泛存在于双腿切开取石位。骨科文献中也有关于半侧截骨术时双腿在骨折台上发生这种并发症的报道。本研究的目的是确定由这种类型的腿部位置引起的急性筋膜间室综合征的危险因素。方法：8名健康志愿者放置在骨折床上。用狭缝导管连续测量受试者仰卧、小腿支撑半切开位、足跟支撑但小腿自由时左腿四个腔室的肌内压力。结果：从仰卧位到小腿支撑位，前室(11.6~19.4 mm Hg)和侧室(13.0~25.8 mm Hg)的肌内压显著升高。从小腿支撑的姿势改变为脚跟支撑的姿势显著降低了前室、侧室和后室的肌内压力(分别为2.8、3.4和1.9毫米汞柱)。仰卧位踝部平均舒张压为63.9 mm Hg，小腿支撑位显著降低至34.6 mm Hg。改变到脚跟支撑位置对踝部的舒张压没有显著影响(平均为32.8 mm Hg)。仰卧位的肌内压和舒张压的平均差值约为50毫米汞柱。这一平均差值显著下降到
Background: Acute compartment syndrome has been widely reported in legs positioned in the lithotomy position for prolonged general surgical, urologic, and gynecologic procedures. The orthopaedic literature also contains reports of this complication in legs positioned on a fracture table in the hemilithotomy position. The purpose of this study was to identify the risk factors for development of acute compartment syndrome resulting from this type of leg positioning.Methods: Eight healthy volunteers were positioned on a fracture table. Intramuscular pressures were continuously measured with a slit catheter in all four compartments of the left leg with the subject supine, in the hemilithotomy position with the calf supported, and in the hemilithotomy position with the heel supported but the calf free. Blood pressure was measured intermittently with use of automated pressure cuffs.Results: Changing from the supine to the calf-supported position significantly increased the intramuscular pressure in the anterior compartment (from 11.6 to 19.4 mm Hg) and in the lateral compartment (from 13.0 to 25.8 mm Hg). Changing from the calf-supported to the heel-supported position significantly decreased intramuscular pressure in the anterior, lateral, and posterior compartments (to 2.8, 3.4, and 1.9 mm Hg, respectively). The mean diastolic blood pressure in the ankle averaged 63.9 mm Hg in the supine position, which significantly decreased to 34.6 mm Hg in the calf-supported position. Changing to the heel-supported position had no significant effect on the diastolic blood pressure in the ankle (mean, 32.8 mm Hg). The mean difference between intramuscular pressure and diastolic blood pressure in the supine position was approximately 50 mm Hg in each of the four compartments. This mean difference significantly decreased to