Беседы о субфасциальном давлении
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#3
19.12.2008, 18:04
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Делают. Даже диссертации пишут.
 
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#5
19.12.2008, 18:42
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Цитата:
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#6
19.12.2008, 19:05
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Насколько помогает в выборе тактики - сказать не могу. Не измеряем. Нечем. Не заказываем.
PS Что-то нитка Мельникова вспомнилась.
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#7
19.12.2008, 22:29
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Наверное, лигатура Мельникова. Это по поводу контроля за отеком.
Для FRSM - Насчет того, что лет двадцать уже никто не измеряет давление, приведу цитату из книги, на которую как-то ссылались и Вы в своем ответе на какую-то мою мысль. "Although the diagnosis of compartment syndrome is made clinically, confirmation is aided with measurement of intracompartmental tissue fluid pressure". - Richard A. Berger, Arnold-Peter C. Weiss. Hand Surgery. - 2004.- P.1570. Сам я тоже не измерял и не измеряю давление, так как нет у меня страйкеровской системы, а знаменитый профессор мне ее не дает, хотя и хвастается, что эта система у него есть. Поэтому читаю иностранные книжки, а там-то про это все почему-то написано.
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#8
20.12.2008, 00:25
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Голоса, рад, что Вы читаете книжки. В данном случае речь идёт не о руке, а о ноге - маленькая такая анатомическая разница.
Да и в плане руки надо, пожалуй, вдуматься в смысловое значение. Интересно, однако, не нижеследуюшая ли халтура привела к обсуждению: SAVKA I. S. ; BOIKO S. A. ; Résumé / Abstract As many as 35 servicemen presenting with a pathological reorganization and stress fractures of shin bones and foot were examined. A measurement of the subfascial pressure was done together with a study of pulse propagation along the tibial and fibial nerves and of bioelectrical activity of foot muscles innervated by the above nerves. The subfascial pressure in the anterior and posterior deep sheaths of the shin appeared to be increased in rest, especially so in the wake of physical loads on the affected extremity even if the process was localized in the foot. The velocity of the pulse propagation along the nerves was found to be decreased, the latent period increased, amplitude decreased, the duration of M-response longer in the affected extremity, with a 38 to 47% decrease in the frequency and amplitude of biological activity of maximum muscular contraction having been recordable. The latter observation has corraborated our assumption that in weight-bearing disease of the extremities there would be present a chronic compartment-syndrome which is of reccurent character, causes disturbances in the neuromuscular apparatus of the extremity (ischemic demyelinization of the nerve fibers and dystrophic changes in the muscles innervated by the above nerve fibers), which fact may lead to recurrences of weight-bearing disease, prolonged treatment and restoration of the function. Revue / Journal Title Likars'ka sprava 2002, no1, pp. 143-146 [4 page(s) (article)] Langue / Language Russe Revue : Multilingue Editeur / Publisher Zdorov'â, Kiìv, UKRAINE (1992) (Revue)
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#9
20.12.2008, 18:38
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Цитата:
Да, а если Вам не понравилась моя предыдущая ссылка, то даю еще одну, опять двадцатилетней давности. Browner B.D. Skeletal Trauma: Basic Science, Management, and Reconstruction, 3rd ed, - 2003. - Section I, Chapter 12 – Compartment Syndromes. И вот в этой главе есть раздел, который называется “TISSUE PRESSURE MEASUREMENTS”. Почитайте, там все подробно написано и про ноги, и про руки. Цитата:
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#11
20.12.2008, 19:17
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#13
21.12.2008, 05:06
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#14
21.12.2008, 13:00
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Примерное состояние дел на сегодня:
1: J Orthop Trauma. 2008 Sep;22(8):581-7. Links Diagnostic techniques in acute compartment syndrome of the leg.Shadgan B, Menon M, O'Brien PJ, Reid WD. Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada. [Ссылки доступны только зарегистрированным пользователям ] OBJECTIVES: To review the efficacy of the current diagnostic methods of acute compartment syndrome (ACS) after leg fractures. DATA SOURCES: A Medline (PubMed) search of the English literature extending from 1950 to May 2007 was performed using "compartment syndromes" as the main key word. Also a manual search of orthopaedic texts was performed. STUDY SELECTION AND EXTRACTION: The results were limited to articles involving human subjects. Of 2605 primary titles, 489 abstracts limited to compartment syndromes in the leg and 577 articles related to the diagnosis of compartment syndromes were identified and their abstracts reviewed. Further articles were identified by reviewing the references. Sixty-six articles were found to be relevant to diagnostic techniques for compartment syndrome in the leg and formed the basis of this review. CONCLUSIONS: Early diagnosis of an ACS is important. Despite its drawbacks, clinical assessment is still the diagnostic cornerstone of ACS. Intracompartmental pressure measurement can confirm the diagnosis in suspected patients and may have a role in the diagnosis of this condition in unconscious patients or those unable to cooperate. Whitesides suggests that the perfusion of the compartment depends on the difference between the diastolic blood pressure and the intracompartmental pressure. They recommend fasciotomy when this pressure difference, known as the Delta p, is less than 30 mm Hg. Access to a precise, reliable, and noninvasive method for early diagnosis of ACS would be a landmark achievement in orthopaedic and emergency medicine.
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#15
21.12.2008, 13:05
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Линейный вид
