Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SU, Scotland.
J Bone Joint Surg Am. 2013 Apr 17;95(8):673-7. doi: 10.2106/JBJS.K.01731.
The aim of our study was to document the estimated sensitivity and specificity of continuous intracompartmental pressure monitoring for the diagnosis of acute compartment syndrome.
From our prospective trauma database, we identified all patients who had sustained a tibial diaphyseal fracture over a ten-year period. A retrospective analysis of 1184 patients was performed to record and analyze the documented use of continuous intracompartmental pressure monitoring and the use of fasciotomy. A diagnosis of acute compartment syndrome was made if there was escape of muscles at fasciotomy and/or color change in the muscles or muscle necrosis intraoperatively. A diagnosis of acute compartment syndrome was considered incorrect if it was possible to close the fasciotomy wounds primarily at forty-eight hours. The absence of acute compartment syndrome was confirmed by the absence of neurological abnormality or contracture at the time of the latest follow-up.
Of 979 monitored patients identified, 850 fit the inclusion criteria with a mean age of thirty-eight years (range, twelve to ninety-four years), and 598 (70.4%) were male (p < 0.001). A total of 152 patients (17.9%) underwent fasciotomy for the treatment of acute compartment syndrome: 141 had acute compartment syndrome (true positives), six did not have it (false positives), and five underwent fasciotomy despite having a normal differential pressure reading, with subsequent operative findings consistent with acute compartment syndrome (false negatives). Of the 698 patients (82.1%) who did not undergo fasciotomy, 689 had no evidence of any late sequelae of acute compartment syndrome (true negatives) at a mean follow-up time of fifty-nine weeks. The estimated sensitivity of intracompartmental pressure monitoring for suspected acute compartment syndrome was 94%, with an estimated specificity of 98%, an estimated positive predictive value of 93%, and an estimated negative predictive value of 99%.
The estimated sensitivity and specificity of continuous intracompartmental pressure monitoring for the diagnosis of acute compartment syndrome following tibial diaphyseal fracture are high; continuous intracompartmental pressure monitoring should be considered for patients at risk for acute compartment syndrome.
我们研究的目的是记录连续间隔压监测对急性间隔综合征诊断的估计敏感性和特异性。
从我们的前瞻性创伤数据库中，我们确定了在十年期间发生胫骨骨干骨折的所有患者。对 1184 名患者进行回顾性分析，以记录和分析连续间隔压监测的记录使用情况以及筋膜切开术的使用情况。如果筋膜切开术中肌肉逃逸和/或肌肉颜色改变或术中肌肉坏死，则诊断为急性间隔综合征。如果在 48 小时内可以直接关闭筋膜切开术伤口，则认为急性间隔综合征的诊断不正确。在最新随访时没有神经功能障碍或挛缩即可确认不存在急性间隔综合征。
在所确定的 979 名监测患者中，850 名符合纳入标准，平均年龄为 38 岁（范围为 12 至 94 岁），598 名（70.4%）为男性（p < 0.001）。共有 152 名患者（17.9%）因急性间隔综合征而行筋膜切开术治疗：141 名患者患有急性间隔综合征（真阳性），6 名患者没有（假阳性），5 名患者尽管间隔压读数正常，但仍行筋膜切开术，随后的手术发现与急性间隔综合征一致（假阴性）。在未行筋膜切开术的 698 名患者（82.1%）中，在平均随访时间为 59 周时，有 689 名患者没有任何急性间隔综合征的晚期后遗症（真阴性）。间隔内压力监测对疑似急性间隔综合征的估计敏感性为 94%，特异性为 98%，阳性预测值为 93%，阴性预测值为 99%。
胫骨骨干骨折后连续间隔压监测对急性间隔综合征的诊断具有较高的估计敏感性和特异性；应考虑对有发生急性间隔综合征风险的患者进行连续间隔压监测。
