No abstract

Apresentamos os resultados da aplicação do Índice da Síndrome da Extremidade Esmagada (Mangled Extremity Syndrome Index - MESI) em 64 fraturas expostas de membros inferiores. As extremidades consideradas esmagadas pelos critérios do MESI, em um total de vinte, foram pontuadas e representam a base deste estudo. De acordo com a escala, o limite de 20 pontos define se a extremidade deve ou não ser preservada. Apenas dois membros foram submetidos à amputação primária (escores de 15 e 20) e, após 19 meses, estavam conformados com a decisão tomada, não utilizavam órteses e deambulavam com auxílio de muletas. Os pacientes que apresentaram os resultados mais desanimadores na reavaliação, obtiveram escores de 16 e 13 pontos e tiveram o membro preservado. Concluiu-se que os critérios do MESI levaram à determinação do que é chamado de Síndrome da Extremidade Esmagada. A pontuação das lesões não foi feita com facilidade e dificilmente atingiu o escore de 20, que determinaria a amputação primária. Em nossa casuística, a preservação do membro com escore abaixo de 20 não significou que a decisão tenha sido a mais acertada.

ObjectivesMuscle injury due to crushing (muscle compression injury) is associated with systemic manifestations known as crush syndrome. A systemic inflammatory reaction may also be triggered by isolated muscle injury. The aim of this study was to investigate the plasma levels of interleukins (IL) 1, 6 and 10 and tumor necrosis factor alpha (TNF-α), which are markers for possible systemic inflammatory reactions, after isolated muscle injury resulting from lower-limb compression in rats.MethodsMale Wistar rats were subjected to 1 h of compression of their lower limbs by means of a rubber band. The plasma levels of IL 1, 6 and 10 and TNF-α were measured 1, 2 and 4 h after the rats were released from compression.ResultsThe plasma levels of IL 10 decreased in relation to those of the other groups, with a statistically significant difference (p < 0.05). The method used did not detect the presence of IL 1, IL 6 or TNF-α.ConclusionOur results demonstrated that the changes in plasma levels of IL 10 that were found may have been a sign of the presence of circulating interleukins in this model of lower-limb compression in rats.

ObjectiveCrush syndrome is characterized by traumatic muscular injuries with severe systemic clinical repercussions. The systemic inflammatory reaction characterized acutely by infiltration of neutrophils in the lungs has been studied as part of the spectrum of crush syndrome. Experimental research may demonstrate alternative treatments for crush syndrome. The authors studied the hypothesis that hypertonic saline solution (7.5% NaCl) could minimize the local and systemic effects in a model of muscular compression and hemorrhagic shock.MethodsRabbits were submitted to a new model of muscle compression associated with hemorrhagic shock. Compression was applied through an Esmarch bandage, used for 1 h on the entire right lower limb. Hemorrhagic shock was induced for 1 h by dissection and catheterization of the carotid artery. Blood replacement or hypertonic saline solution was used to treat the shock. Biochemical analysis of plasma, quantification of muscular edema, and infiltration of inflammatory cells in the lungs were carried out.ResultsAnimals treated with hypertonic solution presented the same hemodynamic response as the blood treated patients, less water in the compressed muscles and less infiltration of inflammatory cells in the lungs. The blood group presented hypocalcemia, a facet of crush syndrome.ConclusionsThe proposed model was effective for the study of crush syndrome associated with hemorrhagic shock. The treatment with hypertonic solution showed benefits when compared with blood volume replacement.