Tibia cisim kırıklı, kooperasyon kurulamayan, politravmalı hastaların kompartman sendromu açısından izlemi
Küçük Resim Yok
Tarih
2004
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
AMAÇ: Tibia cisim kırıklı, kooperasyon kurulamayan politravmalı hastalarda uygulanan intrakompartmantal basınç monitörizasyonunun sonuçları değerlendirildi. GEREÇ VE YÖNTEM: Yoğun bakım ünitesinde izlenen politravmalı 26 hastanın (9 kadın, 17 erkek; ort. yaş 36; dağılım 15-75) 29 tibia cisim kırığı çalışmaya alındı. Sekiz olguda sağ, 15 olguda sol tarafta kırık vardı; üç olguda kırık iki taraflı idi. En sık yaralanma nedeni trafik kazası (%92) idi. Olguların tümünün bilinci kapalıydı. Travma sonrasında 12 saatlik dilimlerle, mutlak kompartman basınçları ve AP (diyastolik kan basıncı mutlak kompartman basıncı) kompartman içi basınç ölçme cihazı ile altı kez ölçüldü. Basınç farkının 30 mmHg veya altında saptandığı olgularda fasyotomi uygulandı. Hastalar tedaviden sonra ortalama 21.2 ay (dağılım 18-25 ay) süreyle izlendi. BULGULAR: Yetmiş iki saatlik sürecin tamamına ait mutlak kompartman basıncı ortalaması 30.25 mmHg, AP ortalaması 48.47 mmHg bulundu. İki olguda (%7) AP değerinin 30 mmHg'nin altında saptanması nedeniyle akut kompartman sendromu tanısı kondu ve fasyotomi uygulandı. Hastaların hiçbirinde akut kompartman sendromuna bağlı komplikasyon görülmedi. Tüm kırıklarda ek bir girişime gerek duyulmadan kaynama elde edildi. Ortalama kaynama süresi 5.21 ay (dağılım 3-9 ay) bulundu. SONUÇ: Kooperasyon kurulamayan, politravmalı tibia kırıklı hastalarda akut kompartman sendromunun erken tanısı için kompart-man içi basınç monitörizasyonu önemlidir.
BACKGROUND: The results of intracompartmental pressure monitoring were assessed in uncooperative, polytraumatized patients with tibial shaft fractures. METHODS: The study included 29 tibial fractures of 26 polytraumatized patients (9 females, 17 males; mean age 36 years; range 15 to 75 years) admitted to the intensive care unit. The fractures were on the right side in eight patients, on the left in 15 patients. Three patients had bilateral involvement. All the patients were unconscious. Following trauma, absolute compartment pressures and P (diastolic blood pressure – absolute compartment pressure) were monitored at 12-hour intervals for 72 hours via the intracompartmental pressure monitoring system. Patients whose ?P values were 30 mmHg or below underwent fasciotomy. The mean follow-up period was 21.2 months (range 18 to 25 months). RESULTS: The overall mean absolute compartment pressure was 30.25 mmHg, and the mean ?P was 48.47 mmHg at the end of 72 hours. Fasciotomy was performed in two patients (7%) in whom a diagnosis of acute compartment syndrome was made depending on ?P values less than 30 mmHg. None of the patients had complications associated with acute compartment syndrome. Union was achieved in all the patients without an additional intervention. The mean time to union was 5.21 months (range 3 to 9 months). CONCLUSIONS: Intracompartmental pressure monitoring should be considered for an early diagnosis of acute compartment syndrome in uncooperative, polytraumatized patients with tibial shaft fractures.
BACKGROUND: The results of intracompartmental pressure monitoring were assessed in uncooperative, polytraumatized patients with tibial shaft fractures. METHODS: The study included 29 tibial fractures of 26 polytraumatized patients (9 females, 17 males; mean age 36 years; range 15 to 75 years) admitted to the intensive care unit. The fractures were on the right side in eight patients, on the left in 15 patients. Three patients had bilateral involvement. All the patients were unconscious. Following trauma, absolute compartment pressures and P (diastolic blood pressure – absolute compartment pressure) were monitored at 12-hour intervals for 72 hours via the intracompartmental pressure monitoring system. Patients whose ?P values were 30 mmHg or below underwent fasciotomy. The mean follow-up period was 21.2 months (range 18 to 25 months). RESULTS: The overall mean absolute compartment pressure was 30.25 mmHg, and the mean ?P was 48.47 mmHg at the end of 72 hours. Fasciotomy was performed in two patients (7%) in whom a diagnosis of acute compartment syndrome was made depending on ?P values less than 30 mmHg. None of the patients had complications associated with acute compartment syndrome. Union was achieved in all the patients without an additional intervention. The mean time to union was 5.21 months (range 3 to 9 months). CONCLUSIONS: Intracompartmental pressure monitoring should be considered for an early diagnosis of acute compartment syndrome in uncooperative, polytraumatized patients with tibial shaft fractures.
Açıklama
Anahtar Kelimeler
Konu Ataması Yapılmamış
Kaynak
Ulusal Travma Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
10
Sayı
2
