筋膜间室压测量-课件.ppt

筋膜室压的测量,AP and lateral views of a Tscherne type 2 tibial shaft fracture. 2型胫腓骨折正侧位片,Within approximately one hour of presentation, the patients skin began to blister.大约一小时内病人 皮肤开始出现水泡,A blood filled blister.水泡内充血,A clear blister.清晰的水泡,The patient was brought to the operating room for treatment of his tibial shaft fracture. On examination in the operating room, his leg felt tense and he had pain on passive stretch of the anterior compartment before being anesthetized.在手术室准备手术胫骨骨折，麻醉之前病人感到小腿胫 前胀痛和被动牵拉痛,Compartment pressures were therefore measured in all four compartments. The area to be tested is cleaned with betadine. 准备测4个筋膜室压力，正在用聚维酮碘消毒,There are multiple devices made for this technique. This image shows one of them.组合式压力仪,It is important that when using the device it is held parallel with the floor so as not to adversely affect the measurement. This is also the case when using other techniques, such as arterial line measurement, where the transducer must be at the level of the examination.必须与地面保持水平以 免影响测量，否则会影响传感器。,The syringe is filled with fluid 注射器装填液体,and then zeroed数值归零,Measuring compartment pressures using a location relatively close to the fracture site has been demonstrated to give slightly more accurate (increased) readings.越靠近骨折端的筋膜室获得读数越精确。,This is done whenever possible. The pressure in the anterior musculature is taken first. After introducing the needle through the fascia, the plunger is gently advanced to cause inflow of a small amount of fluid and the pressure is allowed to equilibrate. 第一步先测胫前筋膜室，针头穿透筋膜后轻推注射器，保持压力平衡。,The patient had a diastolic pressure before induction of anesthesia of 74mm of mercury. Thus a compartment syndrome was diagnosed in the anterior compartment (74 - 66 = 8). 病人麻醉前心舒张压是74mmHg，所以筋膜室综合征诊断成立。,Pressure in the lateral compartment is measured next, just posterior to the fibula. The pressure in the lateral compartment was 45.继续测量外侧筋膜室，压力是45.,ANTERIOR PRESSURE MEASURED HERE,Next, compartment pressure in the posterior compartments are measured by introducing the device just posterior to the tibia medially, allowing measurement of first the superficial, and by farther advancement, the deep compartment.后侧筋膜室压测量从胫骨内侧进入，先浅后深。,The posterior compartments did not have pressures within 30mm Hg of the diastolic pressure and were considered not to have developed compartment syndromes, yet.后侧筋膜室压与心舒张压差不在30内，故未诊断筋膜室压综合征。,After anterior and lateral compartment fasciotomy, the patient was treated with an unreamed, stat