The Incidence and Risk Factors Associated With the Need for Fasciotomy in Tibia and Forearm Fractures: An Analysis of the National Trauma Data Bank.
The Incidence and Risk Factors Associated With the Need for Fasciotomy in Tibia and Forearm Fractures: An Analysis of the National Trauma Data Bank.
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DOI：
10.1097/bot.0000000000001702
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发表时间：
2020-05
影响因子：
2.3
通讯作者：
Miller AN
中科院分区：
文献类型：
--
作者：
Saiz AM Jr;Wellman AC;Stwalley D;Wolinsky P;Miller AN
胫骨和前臂骨折是发展为急性骨筋膜室综合征(ACS)并需要筋膜切开术的高危损伤。这些损伤的筋膜切开术的发生率在文献中差异很大，危险因素也是如此。这项研究的目的是分析一个大型国家创伤数据库，以确定骨折后小腿或前臂筋膜切开术的发生率、危险因素和结果。分析了国家创伤数据库2004-2016年的数据，我们发现了301,351名前臂骨折患者和369,237名胫骨骨折患者。评估危险因素、住院时间(LOS)和死亡率，以确定与需要筋膜切开术的损伤的相关性。1.22%的前臂骨折和3.79%的胫骨骨折行筋膜切开。与未接受筋膜切开术的患者相比，接受筋膜切开术的患者更有可能有侵入性操作(p<；0.0001)；机械、机动车碰撞和枪支造成的损伤(p<；0.0001)；以及吸烟、使用药物和/或酒精(p<；0.0001)。面部切开术与更长的LOS和更高的死亡率相关(p<；0.05)。在胫骨或前臂骨折中，筋膜切开术的发生率不到5%。接受筋膜切开术的患者有：更高的能量损伤，更多的酒精或药物使用，更高的手术干预率，以及更多的LOS。此外，筋膜切开术与死亡率的增加有关。在咨询病人和评估外科医生/医院的表现时，筋膜切开术可以作为更复杂的创伤病理的指标和修饰物。第三级，预后预测
Tibia and forearm fractures are high-risk injuries for developing an acute compartment syndrome (ACS) with need for fasciotomy. The incidence of fasciotomies for these injuries varies widely in the literature, as do the risk factors. The aims of this study were to analyze a large national trauma database to determine the incidence of, risk factors for, and outcomes after a fasciotomy of the lower leg or forearm after fracture. Data from the National Trauma Data Bank for the years 2004 – 2016 were analyzed and we identified 301,351 patients with forearm fractures and 369,237 patients with tibial fractures. Risk factors, length of stay (LOS), and mortality were assessed to determine associations with an injury that required a fasciotomy. 1.22% of the forearm fractures and 3.79% of the tibia fractures had a fasciotomy. Patients with a fasciotomy were more likely to have invasive procedures (p < 0.0001); injuries resulting from machinery, motor vehicle collisions, and firearms (p < 0.0001); and smoke, use drugs and/or alcohol (p < 0.05) compared with patients that did not undergo fasciotomies. Facsiotomy procedures were associated with longer LOS and higher mortality rate (p < 0.05). The incidence of a fasciotomy is less than 5% in tibia or forearm fractures. Patients who underwent fasciotomy have: higher energy injuries, increased alcohol or drug use, higher rates of surgical interventions, and increased LOS. Furthermore, having a fasciotomy is associated with increased mortality rate. When counseling patients and evaluating surgeon/hospital performance, fasciotomies can serve as an indicator and modifier for a more complex trauma pathology. Level III, prognostic