Comparison of tissue oxygenation and compartment pressure following tibia fracture

作者：Hansen Erik N; Manzano Givenchy; Kandemir Utku^*; Mok James M

来源：Injury-International Journal of the Care of the Injured, 2013, 44(8): 1076-1080.

DOI：10.1016/j.injury.2012.11.012

• Acute compartment syndrome
• Ischaemia
• Tibia fracture
• Tissue oxygenation
• Trauma
• Intramedullary nailing
• Perfusion pressure
• Compartment pressure
• PmO2
• Fasciotomy

Objective: We investigated the ability of direct continuous measurement of intramuscular tissue oxygenation (PmO2) to detect acute ischaemia in the leg in patients at risk for acute extremity compartment syndrome. Following tibia fracture treated by intramedullary nailing, we compared the proportions of PmO2 and compartment pressure (CP) measurements that met the warning criteria for compartment syndrome.
Methods: Participants included 10 patients sustaining acute isolated closed tibia shaft fractures treated by intramedullary nailing. A tissue oxygenation probe and a CP probe were percutaneously placed into the anterior compartment of the leg. PmO2 and CP in the anterior compartment were measured in the injured leg for 48 h postoperatively. Measurements meeting the warning criteria were defined as PmO2 < 10 mmHg, CP > 30 mmHg and perfusion pressure Delta P < 30 mmHg.
Results: None of the patients developed compartment syndrome. Comparison of CP and PmO2 showed a CP > 30 mmHg in 50.39% of CP measurements in all patients and a PmO2 < 10 mmHg in 0.75% of PmO2 measurements in two patients (P = 0.005). Comparison of Delta P and PmO2 showed a Delta P < 30 mmHg in 31.01% of DP measurements in nine patients and a PmO2 < 10 mmHg in 0.76% of PmO2 measurements in one patient (P = 0.01).
Conclusion: In the absence of compartment syndrome, pressure measurements following tibia fracture treated with intramedullary nailing often met the warning criteria, whereas PmO2 did not, suggesting that measurement of intramuscular tissue oxygenation may represent a potential method for the identification of acute compartment syndrome that deserves continued investigation.

• 出版日期2013-8