摘要：
Osteofascial compartment syndrome (OFCS) is clinically common and is well known to orthopedic surgeons.Clinicians attach great importance to OFCS because of its severe clinical consequences,and decompression of fascial compartment is often performed in emergency treatment.This article reviews the literature on the threshold of fascial compartment decompression proposed by many scholars in the past and discusses the problems in the clinical diagnosis of acute compartment syndrome,especially the inconsistent pressure thresholds as the indication for emergency decompression surgery.By observing calf fractures patients with tension blister,we found that the pressure of fascia decreased sharply upon the appearance of blisters.Meanwhile,the swelling gradually subsided as well as the clinical manifestations of pain and parasthsia.In view of the uncertainty of various thresholds of fascial decompression and self-decompression,the concepts of myofascial self-release law and muscle-swelling syndrome were first proposed.The author believes that when intracompartmental pressure rises to a point,some unknown mechanisms of fascia can achieve self-decompression.Therefore,no compartment syndrome will take place.We also emphasize that the ' muscle-swelling syndrome'should be strictly distinguished from the soft tissue necrosis caused by crush syndrome and acute limb vascular injury,so as to provide more precise treatment.We believe that without external restrictions such as casts,splints and compression bandages,the muscle-swelling syndrome can achieve self decompression by releasing the pressure in the compartment through tension blisters,and there is no need for fasciotomy.%骨筋膜间隔综合征为骨科医师所熟知,临床上比较常见.由于其临床后果较为严重,临床医师极为重视,经常急症行筋膜室减压手术.笔者回顾了过去多位学者提出的筋膜室减压阈值的文献,讨论了骨筋膜间隔综合征临床诊断中存在的问题,尤其是作为急症减压手术指征的压力阈值标准不一.通过临床观察发生张力性水疱的小腿骨折患者,发现肢体筋膜压力随着水疱的出现锐减,其肿胀程度随着水疱的出现逐渐消退,疼痛、麻木等临床表现也逐渐缓解.基于筋膜室减压的各种阈值的不确切性和自我减压现象,首次提出“肌释扼定律”、“肌扼压综合征”等概念,笔者认为筋膜室内压力到一定程度,筋膜通过某些未知机制可实现自我减压,不存在筋膜间隔综合征.并强调肌扼压综合征应与挤压综合征和急性肢体血管损伤造成的肌肉软组织坏死等严格区分开来,提供更精准的治疗.笔者认为,肌扼压综合征在没有外来限制筋膜室容积措施的干预,如石膏、夹板、加压绷带等情况下,其会通过张力性水疱释放筋膜室内过高的压力,达到自我减压,不需要人为切开筋膜.
