{"id":2623,"date":"2025-02-08T21:28:00","date_gmt":"2025-02-08T20:28:00","guid":{"rendered":"https:\/\/kineaphp.fr\/?p=2623"},"modified":"2025-02-23T23:52:10","modified_gmt":"2025-02-23T22:52:10","slug":"syndrome-des-loges","status":"publish","type":"post","link":"https:\/\/kineaphp.fr\/?p=2623","title":{"rendered":"Syndrome des loges"},"content":{"rendered":"\n<div class=\"wp-block-media-text has-media-on-the-right is-stacked-on-mobile\" style=\"grid-template-columns:auto 32%\"><div class=\"wp-block-media-text__content\">\n<p><strong>Epid\u00e9miologie<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Affection rare mais urgence m\u00e9dicale<\/li>\n\n\n\n<li>Incidence aig\u00fce avant-bras : 3 cas \/ 100 000\/an<\/li>\n\n\n\n<li>10 H > 1 F<\/li>\n<\/ul>\n\n\n\n<p><strong>Facteurs de risque<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>69% de SDL suite \u00e0 une fracture<\/li>\n\n\n\n<li>Blessure par \u00e9crasement<\/li>\n\n\n\n<li>Pansement, attelle trop serr\u00e9e<\/li>\n\n\n\n<li>Injection extraveineuse (8% des SDL)<\/li>\n\n\n\n<li>Overdose narcotique, coma \u00e9thylique<\/li>\n\n\n\n<li>Exercice intense avec augmentation trop rapide<\/li>\n<\/ul>\n<\/div><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"779\" height=\"1024\" src=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/02\/image-106-779x1024.avif\" alt=\"\" class=\"wp-image-3571 size-full\" srcset=\"https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/02\/image-106-779x1024.avif 779w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/02\/image-106-228x300.avif 228w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/02\/image-106-768x1009.avif 768w, https:\/\/kineaphp.fr\/wp-content\/uploads\/2025\/02\/image-106-png.avif 860w\" sizes=\"auto, (max-width: 779px) 100vw, 779px\" \/><\/figure><\/div>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Physiopathologie<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Augmentation de la pression \u00e0 l&rsquo;int\u00e9rieur compartiment musculaire ferm\u00e9<\/strong>, qui compromet la circulation, entra\u00eene isch\u00e9mie des structures (muscles, PVN,&#8230;) du compartiment. Les fascias\/enveloppes sont peu extensibles donc compartiment peu tol\u00e9rant au variation de pression : lors augmentation de la pression intra-compartimentale (par trauma\u2026) le flux sanguin diminue et entra\u00eene une hypoxie tissulaire cause de l\u00e9sions musculaires, nerveuses sans intervention chirurgicale<\/li>\n\n\n\n<li><strong>Au niveau cellulaire, diminution de la perfusion capillaire<\/strong> \u21d2 r\u00e9duit l\u2019apport en O2 (cellules musculaire et nerveuse) \u21d2 hypoxie tissulaire \u21d2 d\u00e9faillance des pompes sodium-potassium des membranes cellulaires \u21d2 d\u00e9s\u00e9quilibre osmotique \u21d2 accumulation des radicaux libres + dommages cellulaires par peroxydation lipidiques \u21d2 inflammation locale\/acidose +n\u00e9crose cellulaire progressive \u21d2 d\u00e9gradation menant \u00e0 la lib\u00e9ration de toxique (potassium, myoglobine)<\/li>\n\n\n\n<li>\u21d2 <strong>Complications syst\u00e9miques<\/strong> (insuffisance r\u00e9nale, trouble du rythme\u2026)<\/li>\n\n\n\n<li>=> <strong>Urgence m\u00e9dicale <\/strong>: complications graves irr\u00e9versibles surviennent entre 2 \u00e0 6h<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Diagnostic<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>FDR (fracture, pl\u00e2tre, ph\u00e9nom\u00e8ne compressif ext ou intrins\u00e8que)<\/li>\n\n\n\n<li>Descriptif <strong>douloureux<\/strong> disproportionn\u00e9 par rapport \u00e0 la blessure (signe le plus pr\u00e9coce et sensible), constante et pulsatile non r\u00e9pondant aux analg\u00e9siques ad\u00e9quats<\/li>\n\n\n\n<li>Sympt\u00f4mes neuro (perte de fonction brusque et rapide)<\/li>\n\n\n\n<li>Hyperalgie \/allodynie<strong> d\u2019apparition r\u00e9cente<\/strong><\/li>\n<\/ul>\n\n\n\n<p><strong>Examen physique<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sy douloureux major\u00e9s \u00e0 l\u2019\u00e9tirement passif des muscles +++<\/li>\n\n\n\n<li>Paralysie, paresth\u00e9sie<\/li>\n\n\n\n<li>Oed\u00e8me \u00e0 la palpation (peu fiable)<\/li>\n<\/ul>\n\n\n\n<p><strong>Examen paraclinique <\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Signes cliniques peu fiables (Sn 13-19% + les patients ne sont parfois pas conscient)<\/li>\n\n\n\n<li><strong>Surveillance et mesure pression intra-compartimental<\/strong> : delta P = P diastolique (Avant-bras CL sain de r\u00e9f\u00e9rence) &#8211; P intracompartmental. Si &lt; 30 mmhg => SDL avec fasciotomie d\u2019urgence<\/li>\n\n\n\n<li>=> si P intra-compartimental se rapproche trop de la P diastolique alors risque d&rsquo;isch\u00e9mie et n\u00e9crose tissulaire<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p><strong>Traitements<\/strong><\/p>\n\n\n\n<p><strong>Chirurgie<\/strong><\/p>\n\n\n\n<p>Incision cutan\u00e9e (3cm en dessous du pli du coude jusqu&rsquo;\u00e0 la partie prox du poignet sur la partie ant\u00e9ro-lat de l&rsquo;avant-bras et le fascia = fasciotomie. Exposition compl\u00e8te des muscles fl\u00e9chisseurs pour une compression efficace. Les PVN auront \u00e9t\u00e9 identifi\u00e9s et pr\u00e9serv\u00e9s. Possible incision parall\u00e8le sur la face post\u00e9ro-lat de l&rsquo;avant-bras si n\u00e9cessaire. En incisant en cutan\u00e9e et sous cutan\u00e9e le fascia , on diminue ainsi la pression intra-compartimentale. On laisse souvent ouvert \u00e0 ciel ouvert et on laisse cicatriser.<\/p>\n\n\n\n<p><strong>R\u00e9\u00e9ducation<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Phase post op imm\u00e9diate <\/strong>(S0-S2) : pr\u00e9venir la raideur (doigts poignets coude), r\u00e9duire oedeme et la douleur post-op, favoriser la cicatrisation des plaies<\/li>\n\n\n\n<li><strong>Mobilisation + bilan csq neuro (S3-S6)<\/strong> : EMG (diff\u00e9rencier les l\u00e9sions r\u00e9versible\/irr\u00e9versible) bon ou mauvais pronostic + mob active passive, renfo, sensibilit\u00e9<br>&#8211; Si activit\u00e9 nerveuse (potentiel de fibrillation) d\u00e8s les premi\u00e8res semaines \u21d2 bon pronostic<br>&#8211; Si peu ou pas \u21d2 mauvais pronostic (fibrose musculaire, l\u00e9sion nerveuse trop importante)<\/li>\n\n\n\n<li><strong>R\u00e9cup\u00e9ration fonctionnelle (S6-S12)<\/strong> : t\u00e2ches fonctionnelle sp\u00e9cifique, neuro-dynamique, augmenter le renforcement (on vise neuro aussi)<\/li>\n\n\n\n<li><strong>Retour aux activit\u00e9s (>12s) <\/strong>professionnelles et sportives<\/li>\n<\/ul>\n\n\n\n<p>Education du patient pour \u00e9viter les r\u00e9cidives<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Physiopathologie Diagnostic Examen physique Examen paraclinique Traitements Chirurgie Incision cutan\u00e9e (3cm en dessous du pli du coude jusqu&rsquo;\u00e0 la partie prox du poignet sur la partie ant\u00e9ro-lat de l&rsquo;avant-bras et le fascia = fasciotomie. Exposition&hellip;<\/p>\n<p class=\"more-link-wrapper\"><a href=\"https:\/\/kineaphp.fr\/?p=2623\" class=\"more-link\">Continue Reading<span class=\"screen-reader-text\"> \u00ab\u00a0Syndrome des loges\u00a0\u00bb<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[360],"tags":[],"class_list":["post-2623","post","type-post","status-publish","format-standard","hentry","category-pathologie-coude"],"_links":{"self":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/2623","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2623"}],"version-history":[{"count":7,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/2623\/revisions"}],"predecessor-version":[{"id":3580,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=\/wp\/v2\/posts\/2623\/revisions\/3580"}],"wp:attachment":[{"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2623"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2623"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kineaphp.fr\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2623"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}