Risk factors of muscle necrosis in patients with acute compartment syndrome / 中华创伤杂志

ABSTRACT

Objective:To investigate the risk factors of muscle necrosis in patients with acute compartment syndrome（ACS）.Methods:A retrospective case-control study was conducted for clinical data of 111 ACS patients admitted to West China Hospital, Sichuan University from January 2010 to December 2020, including 84 males and 27 females; age 18-76 years [45（36, 55）years]. Muscle necrosis was presented in 35 patients（necrotic muscle group）, but was not seen in 76 patients（non-necrotic muscle group）. The univariate analysis was performed for the two groups in the demographic data（sex, age, ethnicity, body mass index, smoking history, chronic comorbidities）, injury patterns [ mechianism of injury（low energy injury, high energy injury, crush injury, other injury）, time from injury to treatment, first visit or not, combination with bone fracture or not, open injury or not, presence of tension blisters or not], medical treatment（number of debridements, fasciotomy or not）and laboratory indicators [hemoglobin（Hb）, platelet count（PLT）, white blood cell count（WBC）, prothrombin time（PT）, international normalized ratio（INR）, partially activated prothrombin time（APTT）, fibrinogen（FIB）, D-Dimer（D-D）, alanine aminotransferase（ALT）, aspartate aminotransferase（AST）, albumin（ALB）, intravenous blood glucose（GLU）, creatine kinase（CK）, peak value of CK during hospitalization（natural logarithmic conversion, lnCK）, serum sodium（NA）, serum potassium（K）, serum calcium（CA）]. Further multivariate logistic regression was performed to analyze the independent risk factors of muscle necrosis in ACS patients.Results:The univariate analysis showed that there were statistically significant differences between the two groups in the mechanism of injury, first visit or not, combination with bone fracture or not, number of debridements, Hb, PT, INR, D-D, AST, ALB, GLU, CK and lnCK（ P<0.05）, while not in the basic data, time from injury to treatment, open injury or not, presence of tension blisters or not, fasciotomy or not, PLT, WBC, APTT, FIB, ALT, NA, K and CA（ P>0.05）. The multivariate logistic regression analysis showed that high energy injury（ OR=5.143, 95% CI 1.216-21.758, P<0.05）, crush injury（ OR=22.313, 95% CI 2.625-189.635, P<0.05）, other mechanism of injury（ OR=9.019, 95% CI 1.036-78.554, P<0.05）, first visit or not（ OR=0.071, 95% CI 0.006-0.819, P<0.05）, Hb（ OR=0.979, 95% CI 0.961-0.998, P<0.05）, GLU（ OR=1.218, 95% CI 1.020-1.455, P<0.05）and lnCK（ OR=1.805, 95% CI 1.235-2.639, P<0.05）were significantly related with muscle necrosis. Conclusion:The mechanism of injury, first visit or not, Hb, GLU and lnCK are the independent risk factors of muscle necrosis in patients with ACS.