[**Zibo Municipal Health Commission Work Dynamics].
Recently, the Department of Orthopedic Surgery of Zibo Maternal and Child Health Hospital successfully treated a child on the verge of amputation due to high pressure in the lower calf compartment after a car accident.
According to reports, the child is 15 years old this year, due to a car accident injured the lower leg, resulting in multiple comminuted fractures of the lower leg, due to crush injury, serious trauma, numbness below the ankle on the second day after fracture fixation, pain disappeared, the entire left foot pale, cold, ** left foot 3 main artery pulses are gone.
Subsequently, the emergency ultrasound examination showed that the anterior tibial artery, posterior tibial artery and peroneal artery below the middle of the calf were all showing that the diameter of the canal was getting thinner and thinner from the proximal to the distal end, the blood supply was getting smaller and smaller, and there was no blood flow below the ankle joint. Although the child's ischemic pain symptoms were not obvious due to the postoperative application of the analgesic pump, the patient's calf was swollen obviously, and the tension was high, and Li Guangsheng, the chief physician of the Department of Orthopedic Surgery, diagnosed the patient with compartment syndrome, and judged that the patient would face the risk of amputation if the blood supply was not restored in time.
Immediately, Li Guangsheng led the members of the diagnosis and treatment team, Zhang Kunpeng and Qi Jialin, with the close cooperation of the ultrasound department and the surgical anesthesiology department, to perform emergency calf myofascial incision, osteofascial compartment decompression + VSD negative pressure drainage, and rescue measures such as femoral artery puncture on the affected side + papaverine bolus, hot saline blister washing, and infusion to replenish blood volume, and successfully restored blood supply. Intraoperative and postoperative color ultrasound reexamination confirmed that the blood supply of the affected foot was good. At present, the child has been discharged from the hospital.
Compartment syndrome refers to a series of symptoms and signs caused by limb trauma of various causes, resulting in increased pressure in the compartment and blocking the microcirculation of tissues in the compartment, most commonly after trauma to the extremities. Typical symptoms are pain, local swelling, and limited movement, and in the late stage, the main manifestations are 5P symptoms, including painless, pallor, paresthesia, paralysis, and pulselessness.
Once compartment syndrome is confirmed, fascial incision should be made immediately to decompress. Patients with atypical ischemic pain due to the use of analgesics or analgesic pumps should carefully check the blood vascularity, pay attention to the temperature, color, and most importantly, the distal arterial pulse, weaken or disappear on the healthy side, and when the swelling of the affected limb is severe, timely color ultrasound examination is helpful for early detection and early diagnosis, and if necessary, artiography examination is necessary to avoid delaying the diagnosis and **.
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