Department of Orthopaedics, West Virginia University, Health Sciences Center, Morgantown, WV 26506-9196, USA.
J Bone Joint Surg Am. 2010 Feb;92(2):361-7. doi: 10.2106/JBJS.I.00411.
Serial physical examination is recommended for patients for whom there is a high index of suspicion for compartment syndrome. This examination is more difficult when performed on an obtunded patient and relies on the sensitivity of manual palpation to detect compartment firmness-a direct manifestation of increased intracompartmental pressure. This study was performed to establish the sensitivity of manual palpation for detecting critical pressure elevations in the leg compartments most frequently involved in clinical compartment syndrome.
Reproducible, sustained elevation of intracompartmental pressure was established in fresh cadaver leg specimens. Pressures tested included 20 and 40 mm Hg (negative controls) and 60 and 80 mm Hg (considered to be consistent with a compartment syndrome). Each leg served as an internal control, with three compartments having a noncritical pressure elevation. Orthopaedic residents and faculty were individually invited to manually palpate the leg with a known compartment pressure and to answer the following questions: (1) Is there a compartment syndrome? (2) In which compartment or compartments do you believe the pressure is elevated, if at all? (3) Describe your examination findings as soft, compressible, or firm.
When a true-positive result was considered to be the correct detection of an elevation of intracompartmental pressures and correct identification of the compartment with the elevated pressure, the sensitivity of manual palpation was 24%, the specificity was 55%, the positive predictive value was 19%, and the negative predictive value was 63%. With increasing intracompartmental pressure, fasciotomy was recommended with a higher frequency (19% when the pressure was 20 mm Hg, 28% when it was 40 mm Hg, 50% when it was 60 mm Hg, and 60% when it was 80 mm Hg). When a true-positive result of manual palpation was considered to be an appropriate recommendation of fasciotomy, regardless of the ability of the examiner to correctly localize the compartment with the critical pressure elevation, the sensitivity was 54%, the specificity was 76%, the positive predictive value was 70%, and the negative predictive value was 63%.
Manual detection of compartment firmness associated with critical elevations in intracompartmental pressure is poor.
对于高度怀疑存在筋膜室综合征的患者，建议进行连续体格检查。对于意识障碍的患者，这种检查更加困难，需要依靠手动触诊的敏感性来检测筋膜室的硬度——这是筋膜室内压力升高的直接表现。本研究旨在确定手动触诊检测小腿最常发生的临床筋膜室综合征的临界压力升高的敏感性。
在新鲜的尸体小腿标本中建立可重复的、持续的筋膜室内压力升高。测试的压力包括 20mmHg 和 40mmHg（阴性对照）以及 60mmHg 和 80mmHg（被认为与筋膜室综合征一致）。每条腿作为内部对照，有三个筋膜室存在非临界压力升高。单独邀请骨科住院医师和教员手动触诊已知筋膜室压力的腿部，并回答以下问题：（1）是否存在筋膜室综合征？（2）如果存在压力升高，您认为是哪个或哪些筋膜室升高了？（3）描述您的检查结果是柔软、可压缩还是坚硬。
当正确检测到筋膜室内压力升高并正确识别压力升高的筋膜室被认为是真阳性结果时，手动触诊的敏感性为 24%，特异性为 55%，阳性预测值为 19%，阴性预测值为 63%。随着筋膜室内压力的增加，筋膜切开术的推荐频率也随之增加（压力为 20mmHg 时为 19%，压力为 40mmHg 时为 28%，压力为 60mmHg 时为 50%，压力为 80mmHg 时为 60%）。当将手动触诊的真阳性结果定义为适当推荐筋膜切开术，而不考虑检查者正确定位具有临界压力升高的筋膜室的能力时，敏感性为 54%，特异性为 76%，阳性预测值为 70%，阴性预测值为 63%。
手动检测与筋膜室内压力临界升高相关的筋膜室硬度较差。
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