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Das akute Kompartmentsyndrom der Extremitäten

Diagnostik und Behandlungsmanagement

Acute extremity compartment syndrome

Current concepts in diagnostics and therapy

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Zusammenfassung

Das Kompartmentsyndrom der Extremitäten stellt eine schwere Komplikation nach Trauma, Reperfusions- und Lagerungsschäden dar. Durch eine Druckerhöhung innerhalb einer Muskelloge kommt es, bedingt durch eine andauernde Minderperfusion des Gewebes, zur neuromuskulären Zellschädigung. Großvolumigere Nekrosen gefährden die Extremität, postischämische oder infektiöse Komplikationen können eine vitale Bedrohung darstellen. Die Diagnose des akuten Kompartmentsyndroms wird v. a. klinisch gestellt. Bei Patienten mit gestörtem Bewusstsein oder in Grenzfällen eines drohenden Kompartmentsyndroms ist die apparative Diagnostik (v. a. Logendruckmessung) ein wichtiges und unerlässliches Hilfsmittel. Die Therapie besteht in der Dermatofasziotomie und sekundärer Wundbehandlung. Der sekundäre Wundverschluss erfolgt nach Tagen und in Abhängigkeit des klinischen Verlaufs. Um Folgeschäden zu minimieren, ist das zeitliche Management ab Behandlungsbeginn entscheidend. Im klinischen Alltag sind Behandlungsalgorithmen hilfreich, v. a. hinsichtlich forensischer Implikationen.

Abstract

Acute compartment syndrome of the upper and lower limbs is observed following trauma, reperfusion or as an intraoperative complication caused by positioning. The pathophysiology of the disorder has been extensively described and is well known as a loss of perfusion due to rising compartmental pressures. It is a serious and potentially limb- and life-threatening complication. Early diagnosis is made primarily based on clinical findings. Early and focused therapy is crucial to prevent the devastating complications of this acute condition. However, diagnosis can be difficult, particularly in unconscious patients. Thus, in uncertain cases, pressure measurements are essential. Dermato-fasciotomy is the routine method to decompress the compartmental space. This review article examines the clinical findings, diagnostic techniques, and management options for the patient with musculoskeletal injuries.

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Notes

  1. Das entspricht 666,61 Pa. Im Folgenden wird auf die Umrechnung in die SI-Einheit Pascal verzichtet.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. M. Sellei, F. Hildebrand und H.-C. Pape geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskriptes zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Authors and Affiliations

  1. Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland

    R.M. Sellei, F. Hildebrand & H.-C. Pape

  2. Harald Tscherne Forschungslabor, Klinik für Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Aachen, Aachen, Deutschland

    R.M. Sellei, F. Hildebrand & H.-C. Pape

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  1. R.M. Sellei
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  2. F. Hildebrand
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  3. H.-C. Pape
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Correspondence to R.M. Sellei.

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Sellei, R., Hildebrand, F. & Pape, HC. Das akute Kompartmentsyndrom der Extremitäten. Unfallchirurg 117, 633–649 (2014). https://doi.org/10.1007/s00113-014-2610-7

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  • DOI: https://doi.org/10.1007/s00113-014-2610-7

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