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Trattamento Chirurgico Della Sindrome Compartimentale E Della Sindrome Di Volkmann

A. C. Masquelet
Published 2005 · Art

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Riassunto E ormai invalso definire la sindrome di Volkmann come un complesso di segni che si traducono in una retrazione ischemica degli elementi di una loggia muscolare. La sindrome di Volkmann deve quindi essere considerata la sequela di un evento acuto, precedente, che si e convenuto di denominare “sindrome compartimentale”. Se si estende la definizione di sindrome compartimentale al complesso di manifestazioni cliniche correlate a un aumento della pressione tissutale all’interno di uno spazio non estensibile, allora tutti i pazienti portatori di una lesione degli arti hanno, in un determinato momento, una sindrome compartimentale. Infatti, qualsiasi contusione da parte di un agente esterno, qualsiasi ematoma sottofasciale, qualsiasi intervento chirurgico inducono inevitabilmente pressione tissutale eccessiva. E a questo punto che interviene il concetto di soglia critica (relativa sia all’intensita sia alla durata), oltre la quale la pressione induce lesioni irreversibili che si sviluppano in sequenza. Cio rende necessaria la vigilanza estrema di cui occorre farsi carico, quotidianamente, nella sorveglianza dei pazienti suscettibili di sviluppare un’iperpressione tissutale localizzata. La localizzazione alla gamba e la piu frequente e la piu nota. Piu subdole, ma anch’esse gravate da conseguenze, sono le sindromi compartimentali ritardate, che si sviluppano verso la quarta o quinta giornata dopo il traumatismo iniziale, le sindromi compartimentali profonde che interessano solo un gruppo muscolare e le sindromi compartimentali a carico di un’estremita, mano e piede. A questo titolo, una semplice frattura del calcagno provoca un’iperpressione nella loggia dell’abduttore dell’alluce. Fase cruciale della diagnosi e il momento in cui nasce il sospetto di una sindrome compartimentale. Nessun segno clinico e specifico. La decisione diagnostica e resa piu facile dalle misurazioni ripetute della pressione. La fasciotomia, prontamente realizzata, permette la restitutio ad integrum prima che si instaurino le lesioni iscnemiche dei muscoli e dei nervi tipiche della sindrome di Volkmann. In quest’ultimo stadio, a sindrome conclamata, la chirurgia molto spesso e soltanto palliativa.
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