骨科英文书籍精读（354）｜小腿骨筋膜是综合征的治疗和预后
我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
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Fasciotomy and decompression
Once the diagnosis is made, decompression should be carried out with the minimum delay – and that means decompression of all four compartments at the first operation. This is best and most safely accomplished through two incisions, one anterolateral and one posteromedial. The anterolateral incision is made about 2–3 cm lateral to the crest of the tibia and extends from the level of the tibial tuberosity to just above the ankle (Fig. 30.30). The fascia is split along the length of the anterior and lateral compartments taking care not to damage the superficial peroneal nerve. A second, similar incision is made just posterior to the posteromedial border of the tibia; the fascial covering of the superficial posterior compartment is split. The deep posterior compartment is identified just above the ankle (where its fascial covering is absent) and traced proximally; the muscle bulk of the superficial compartment needs to be retracted posteriorly, exposing the fascial envelope of the deep posterior compartment, which is likewise split down its entire length. Segmental arteries that perforate the fascia from the posterior tibial artery should be preserved for possible use in local skin flaps (Fig. 30.31). The incisions are left open, a well-padded dressing is applied and the leg is splinted with the ankle in the neutral position. The fracture is treated as a grade III open injury requiring a spanning external fixator and prompt return for wound closure or skin grafting.
Outcome
Compartment decompression within 6 hours of the onset of symptoms (or critical pressure measurement) should result in full recovery. Delayed decompression carries the risk of permanent dysfunction, the extent of which varies from mild sensory and motor loss to severe muscle and nerve damage, joint contractures and trophic changes in the foot.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
Fasciotomy and decompression 筋膜切开术和减压
/fæʃi'ɔtəmi/n. [外科] 筋膜切开术
crest/krest/n. [物] 波峰；冠；山顶；顶饰vi. 到达绝顶；形成浪峰
fascia /ˈfeɪʃə/n. 招牌；[医] 筋膜；绷带；
retract/rɪˈtrækt/vt. 缩回；缩进；取消
Segmental arteries that perforate the fascia from the posterior tibial artery should be preserved for possible use in local skin flaps
从胫后动脉穿出筋膜的节段动脉应予以保留，以便在局部皮瓣中使用
Compartment decompression within 6 hours of the onset of symptoms (or critical pressure measurement) should result in full recovery. Delayed decompression carries the risk of permanent dysfunction, the extent of which varies from mild sensory and motor loss to severe muscle and nerve damage, joint contractures and trophic changes in the foot.
在出现症状后6小时内进行室间减压(或测量临界压力)应可导致完全恢复。延迟减压会带来永久性功能障碍的风险，其程度从轻微的感觉和运动丧失到严重的肌肉和神经损伤、关节挛缩和足部营养变化。
critical /ˈkrɪtɪkl/
adj. 鉴定的；[核] 临界的；批评的，爱挑剔的；危险的；决定性的；评论的
有道翻译（仅供参考，建议自己翻译）：
筋膜切开减压
一旦确诊，减压应以最小的延迟进行，这意味着在第一次手术时对所有四个腔室进行减压。这是最好的，最安全地通过两个切口，一个前外侧和一个后内侧。前外侧切口位于胫骨嵴外侧约2–3 cm处，从胫骨粗隆水平延伸至脚踝正上方（图30.30）。筋膜沿前室和外侧室的长度分开，注意不要损伤腓浅神经。第二个类似的切口在胫骨后内侧缘的正后方；浅表后室的筋膜被撕裂。深部后房室位于踝关节上方（没有筋膜覆盖），并向近侧追踪；浅筋膜室的肌块需要向后收缩，露出深筋膜室的筋膜包层，筋膜包层同样被整个长度分开。从胫后动脉穿出筋膜的节段动脉应予以保留，以便在局部皮瓣中使用（图30.31）。切口保持开放，使用垫好的敷料，腿部用夹板固定，脚踝处于中立位置。骨折被视为Ⅲ级开放性损伤，需要一个跨越式外固定架并迅速复位，以闭合伤口或植皮。
结果
症状出现后6小时内的腔室减压（或临界压力测量）应导致完全恢复。延迟减压有永久性功能障碍的风险，其程度从轻微的感觉和运动丧失到严重的肌肉和神经损伤、关节挛缩和足部营养改变不等。