Cole Ashley L, Herman Richard A, Heimlich Jonathan B, Ahsan Sahir, Freedman Brett A, Shuler Michael S
Department of Upper Extremity and Micro Surgery, Athens Orthopedic Clinic, PA, USA.
J Hand Surg Am. 2012 Feb;37(2):297-302. doi: 10.1016/j.jhsa.2011.10.037. Epub 2011 Dec 20.
Near infrared spectroscopy (NIRS), a noninvasive means for monitoring muscle oxygenation, may be useful in the diagnosis of acute compartment syndrome, a condition characterized by poor tissue perfusion. This study used the decrease in muscle oxygenation caused by exercise to investigate the ability of anatomic placement of NIRS sensor pads over compartments of the forearm to isolate perfusion values of a specific compartment.
We recruited 63 uninjured volunteers from a private clinic-based setting and placed NIRS sensor pads over the dorsal, volar, and mobile wad compartments of 1 forearm. A total of 49 participants also had the contralateral forearm monitored, which served as an internal control. Participants performed a series of 3 exercises designed to sequentially activate the muscles of each compartment. A washout period separated each exercise to allow perfusion to return to baseline. We compared NIRS values of each compartment recorded during muscle contraction with baseline values.
Mean NIRS values decreased significantly from baseline during muscle contraction for all compartments, whereas mean NIRS values of muscle compartments that remained at rest showed little or no change. We observed no changes in NIRS values of the contralateral arm, which remained at rest during the entire data collection period.
Although lack of an existing method for quantifying muscle perfusion precludes validation of this technique against a reference standard, this study suggests that NIRS can provide oxygenation values that are both sensitive and specific to muscle compartments of the forearm. Future studies should investigate NIRS among patients with upper extremity injuries.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.
近红外光谱技术（NIRS）是一种监测肌肉氧合的非侵入性方法，可能有助于诊断急性骨筋膜室综合征，这是一种以组织灌注不良为特征的病症。本研究利用运动引起的肌肉氧合下降，来探究将NIRS传感器垫置于前臂各骨筋膜室上的解剖位置，能否分离出特定骨筋膜室的灌注值。
我们从一家私立诊所招募了63名未受伤的志愿者，将NIRS传感器垫置于一侧前臂的背侧、掌侧和活动肌束骨筋膜室上。共有49名参与者的对侧前臂也进行了监测，作为内部对照。参与者进行了一系列3种运动，旨在依次激活每个骨筋膜室的肌肉。每次运动之间设置了洗脱期，以使灌注恢复到基线水平。我们将肌肉收缩期间记录的每个骨筋膜室的NIRS值与基线值进行了比较。
所有骨筋膜室在肌肉收缩期间的平均NIRS值均较基线水平显著下降，而保持静止的骨筋膜室的平均NIRS值几乎没有变化。我们观察到对侧手臂的NIRS值没有变化，在整个数据收集期间该侧手臂一直处于静止状态。
尽管目前缺乏量化肌肉灌注的方法，无法对照参考标准验证该技术，但本研究表明，NIRS能够提供对前臂骨筋膜室敏感且特异的氧合值。未来的研究应调查上肢受伤患者的NIRS情况。
研究类型/证据水平：诊断性研究III级
