筋膜间隔综合征与脂肪栓塞相关性:临床资料分析

Objective To study the correlation between fat embolism(FE)and compartment syndrome (CS)in the mechanism of the diseases.Methods Controlled studies were undertaken in the 2 groups consisting respectively of 111 cases(OG)with the CS after the fracture of a long bone and 279 cases(CG)with this fracture but without the CS.The prevalcence rate(PB)of fat embolism(FE)was compared.The odd ratio(OR)of CS to FE,to ketenceria concurrent with hypertriglyceridemia was respectively analyzed,and the correlation coefficient(CC)between CS and FE was computed.Reults The PR(16.22%)of sub-CFE in the OG was significantly higher than that(9.68%)in the CG(X2=20.71,P＜0.01).The OR to FE was 1.94(95% CI＞1),the OR to the ketenceria was 1.97(95%CI＞1).The CC was 0.66(tr=4.96,P＜0.01).Conclusion The results suggested that the CS belongs to a risk factor resulting in the FE,their correlation being moderate.     

髂肌筋膜间隔综合征7例诊治体会

目的：探讨髂肌筋膜间隔综合征的诊断和治疗。方法：回顾性分析我院收治的7例病人，1例采用穿刺抽血减压，6例采用手术治疗，切开髂肌筋膜，清除血肿减压，均使股神经和股外侧皮神经获得了减压。结果：7例病人通过12-18个月的随访，股四头肌肌力、下肢的感觉及膝反射均恢复正常。结论：在伤后34小时内就诊者，可试行穿刺抽血减压，在伤后48小时的就诊者，应尽早手术切开减压。     

足部筋膜间隔室综合征

筋膜间室综合征发於足部,临床上并不少见,然而常常不被人们所认识,我院近年来有18例足部外伤病人出现筋膜间室综合征,现报告如下。临床资料一、一般资料　18例病人中,男14例,女4例,年龄17～49岁。致伤原因:砸伤6人,辗轧伤9人,坠落伤4人,骨折类型:足跖骨多处多段骨折11人,足距跟骨骨折2人,小腿内外踝骨折并关节脱位5人。其中2人合并小腿筋膜间室高压症,发生前足坏死1人。二、临床表现及治疗(一)临床表现　伤足肿胀,并逐渐加重,局部皮肤有压痛,皮下瘀血皮肤张力增加并有水泡形成,伤足趾被动活动时疼痛剧烈,趾端麻木,感觉减退,足趾部皮肤发紫或…     

筋膜间隔综合征的中西医结合治疗

本文分析了自１９８６年至１９９３年３１例筋膜间隔综合征。采用中西医结合方法治疗。应用甘露醇和活血化瘀中药有改善局部微循环、减轻水肿及疤痕挛缩的作用，疗效可靠。并对甘露醇和活血化瘀中药的作用机理进行了讨论。     

脂肪栓塞综合征早期诊断与抢救

１９８５～１９９３年对６例骨折并发脂肪栓塞综合征经抢救成功５例,死亡１例,现报告如下。临床资料本组６例中,均为男性,年龄２０～３６岁;双胫腓骨骨折１例,股骨骨折３例,多发性骨折２例;车祸４例,工伤２例;治愈５例,死亡１例。临床表现与抢救１病人早期表...     

交锁髓内钉固定术与脂肪栓塞综合征

目的　探讨交锁髓内钉手术方式 (扩髓与不扩髓操作、固定部位、开放与闭合复位方式 )与脂肪栓塞综合征的关系。方法　 2 12例交锁髓内钉手术分别按扩髓与不扩髓操作、手术部位(股骨或胫骨 )、开放与闭合复位方式分组 ,比较各观察因素与脂肪栓塞综合征的关系。结果　扩髓与不扩髓操作脂肪栓塞综合征的发生差异有显著性 (P <0 .0 5 ) ;手术部位、开放与闭合复位对脂肪栓塞的发生无显著性影响 (P >0 .0 5 )。结论　交锁髓内钉手术时扩髓操作能显著增加脂肪栓塞综合征发生的机会 ,而手术部位 (胫骨或股骨 )、复位方式 (开放与闭合 )对脂肪栓塞的发生没有显著影响。     

Late recovery in cerebral fat embolism

Fat embolism syndrome presenting primarily with cerebral manifestations is rarely reported. We report here two such patients who showed complete recovery following initial deterioration. The aim of these reports is to highlight that prolonged intensive care and good rehabilitation can lead to normal neurologic recovery despite poor clinical picture initially. The importance of adequate oxygenation to prevent secondary brain damage is emphasized during prolonged recovery.     

Cerebral fat embolism syndrome after simultaneous bilateral total knee arthroplasty: a case series

Total knee arthroplasty (TKA), particularly when performed as a simultaneous bilateral procedure, theoretically increases the risk for entry of fat globules into the blood stream. The frequency of cerebral fat embolism syndrome (CFES) was retrospectively investigated among 2345 simultaneous bilateral TKA procedures performed from August 2006 to May 2010. During that period, 9 patients presented with neurologic deficits after surgery and underwent brain magnetic resonance imaging. For identification of CFES among them, we used both magnetic resonance imaging findings and clinical criteria modified from the original one of Gurd and Wilson (J Bone Joint Surg Br 1974; 56B:408). Four patients fulfilled the modified criteria. The overall incidence of CFES occurring after simultaneous bilateral TKA was 0.17%. Cerebral fat embolism syndrome should be ruled out, although rare, in patients who present with neurologic impairment after TKA.     

High frequency jet ventilation in fat embolism syndrome

The use of high frequency jet ventilation in the management of a patient with fat embolism syndrome is described. Its principal advantage over conventional intermittent positive pressure ventilation is a reduction in the amount of sedation necessary.     

The effect of patient position during trauma surgery on fat embolism syndrome: An experimental study

Background:

The aim of this study was to compare the effect of supine versus lateral position on clinical signs of fat embolism during orthopedic trauma surgery. Dogs served as the current study model, which could be extended and/or serve as a basis for future in vivo studies on humans. It was hypothesized that there would be an effect of position on clinical signs of fat embolism syndrome in a dog model.

Materials and Methods:

12 dogs were assigned to supine (n = 6) and lateral (n = 6) position groups. Airway pressures, heart rate, blood pressure, cardiac output, pulmonary artery pressure, pulmonary artery wedge pressure, right atrial pressure, arterial and venous blood gases, white blood count, platelet count and neutrophil count were obtained. Dogs were then subjected to pulmonary contusion in three areas of one lung. Fat embolism was generated by reaming one femur and tibia, followed by pressurization of the canal.

Results:

No difference was found in any parameters measured between supine and lateral positions at any time (0.126 < P < 0.856).

Conclusions:

The position of trauma patients undergoing reamed intramedullary nailing did not alter the presentation of the features of the lung secondary to fat embolism.     

脂肪栓塞综合征的临床表现及影像诊断分析

目的：探讨脂肪栓塞综合征患者的临床及影像学表现特点。方法：自2021年1月至2022年10月回顾性分析13例因骨折或骨科手术发生脂肪栓塞患者的临床表现,其中男11例,女2例;年龄17～60岁。入院后或术后发生精神及呼吸异常、生命体征改变,患者胸部、颅脑影像检查结果异常,对患者的精神及呼吸异常、生命体征、胸部及颅脑影像结果进行连续监测。结果：主要临床表现肺呼吸异常13例、中枢神经功能异常7例、斑点皮疹2例,胸部CT结果表现为弥漫性分布的磨玻璃影13例,严重时表现为“暴风雪”征;9例磨玻璃样融合实变;5例可见多发结节影;4例伴有双侧胸腔积液。5例头颅CT表现为阴性,1例头颅MRI表现为基底节区、放射冠、半卵圆中心、丘脑及额顶叶皮层及皮层下多发T1WI低信号,T2WI高信号影,DWI高信号影,表现为“星空征”。结论：脂肪栓塞综合征致死率高,呼吸系统及神经系统的临床表现没有特异性,皮肤斑点皮疹具有特征性表现;“暴风雪”征是脂肪栓塞胸部X线及CT检查的特异性表现,“星空征”是脂肪栓塞颅脑MRI检查弥散加权序列的典型表现。     

吸脂术后脂肪栓塞综合征的诊治

目的：总结吸脂术后发生脂肪栓塞综合征时的诊断治疗经验。方法：统计分析吸脂术后出现脂肪栓塞症状患者的诊断和治疗程序,对其过程特点加以总结。结果：确诊的6例患者经及时抢救治疗后均恢复正常,远期无后遗症出现。结论：吸脂患者术后应在48h内严密观察生命体征,有异常情况者及时检查和治疗。     

Abdominal compartment syndrome: urological aspects

ACS is prevalent in various surgical conditions and in a large percentage of critically ill patients. Measuring the IAP is important in the early diagnosis of ACS and can be easily done by measuring the intravesical pressure. ACS adversely affects many organ systems; the pathogenesis of renal dysfunction is probably multifactorial, from a combination of reduced cardiac output, reduced GFR mediated by secretion of renin and angiotensin, aldosterone-mediated water reabsorption, increased renal parenchymal pressure and direct compression of the renal vein. Successful treatment requires a high index of suspicion, prompt recognition and early surgical abdominal decompression.     

小切口减张术治疗下肢骨筋膜室综合征临床研究

目的观察小切口减张术治疗下肢骨筋膜室综合征的疗效。方法回顾性分析南京大学医学院附属鼓楼医院1992年2月至2005年7月收治的37例下肢动脉栓塞术后再灌注损伤致小腿骨筋膜室综合征病人资料。均采用小切口减张术(即在小腿内、外侧各取纵行切口,长2~3cm,游离皮下组织直至深筋膜,打开深筋膜,将剪刀伸进切口内,分别向近、远端潜行剪开深筋膜,上至膝关节下,下至内踝)治疗。同时结合高渗脱水、利尿、伤口延期缝合等,观察其疗效。结果37例病人中33例痊愈,2例发生足趾坏疽行截趾术,2例出现小腿感觉障碍,给予营养神经药物治疗3个月后恢复,无一例发生缺血性肌痉挛及高位截肢。其中22例微小减张切口行Ⅱ期缝合,15例自行愈合,无一例植皮。结论小切口减张术用于骨筋膜室综合征具有损伤轻微、创面小、细胞外液和蛋白损失少、感染概率相对较低,部分小切口能够自行愈合、无须Ⅱ期缝合或植皮等优点,方法实用,值得推广。