Pasic Nick, Bryant Dianne, Willits Kevin, Whitehead David
Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada.
Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada.
Arthroscopy. 2015 Apr;31(4):707-713.e5. doi: 10.1016/j.arthro.2014.10.018. Epub 2014 Dec 25.
The purposes of this study were to evaluate patient-reported outcomes after fasciotomy of the leg for chronic exertional compartment syndrome (CECS) and to determine the rate at which revision surgery was required and the prognostic value of intracompartmental pressure (ICP) testing.
This was a retrospective consecutive case series of patients with CECS who underwent preoperative ICP testing and surgical fasciotomy for treatment of CECS of the leg between September 2001 and January 2012.
Of 69 eligible patients, 46 were evaluated at a mean follow-up time of 54.9 months (range, 3.9 to 127.3 months). Forty-two patients met the Pedowitz criteria for CECS diagnosis. Mean score on the Lower Extremity Functional Scale (LEFS) was 70.4 (standard deviation [SD] ± 11.2) at follow-up and 72.3 (SD ± 11.2) at the patient-perceived time of best outcome. Best outcome was reported at a mean time of 14.3 months (range, 0.5 to 84 months). Five of 46 (11%) patients required a revision fasciotomy. Thirty-six of 46 (78%) patients reported being either satisfied (n = 14) or very satisfied (n = 22) at follow-up. The Pedowitz criteria were highly sensitive (97%) but not specific (10%) and had a positive predictive value (PPV) of 79%.
Functional outcomes after fasciotomy for CECS were favorable. ICP testing was shown to be sensitive but not specific. Revision surgery was required for 5 of the 46 patients (11%). Patient satisfaction rates, return to sport, return to preoperative activity levels, and LEFS scores were all high. This case series confirms that fasciotomy is a safe and effective surgical treatment for CECS.
Level IV, therapeutic case series.
本研究旨在评估慢性运动性骨筋膜室综合征（CECS）患者行小腿筋膜切开术后的患者报告结局，确定翻修手术的需求率以及骨筋膜室内压力（ICP）测试的预后价值。
这是一项回顾性连续病例系列研究，纳入2001年9月至2012年1月期间因小腿CECS接受术前ICP测试和手术筋膜切开术治疗的患者。
69例符合条件的患者中，46例接受评估，平均随访时间为54.9个月（范围3.9至127.3个月）。42例患者符合CECS诊断的佩多维茨标准。随访时下肢功能量表（LEFS）的平均得分是70.4（标准差[SD]±11.2），在患者认为的最佳结局时间平均得分是72.3（SD±11.2）。最佳结局报告的平均时间为14.3个月（范围0.5至84个月）。46例患者中有5例（11%）需要进行翻修筋膜切开术。46例患者中有36例（78%）在随访时报告满意（n = 14）或非常满意（n = 22）。佩多维茨标准具有高度敏感性（97%）但不具有特异性（10%），阳性预测值（PPV）为79%。
CECS筋膜切开术后的功能结局良好。ICP测试显示敏感但不具特异性。46例患者中有5例（11%）需要进行翻修手术。患者满意度、恢复运动、恢复到术前活动水平以及LEFS评分均较高。本病例系列证实筋膜切开术是治疗CECS的一种安全有效的手术方法。
IV级，治疗性病例系列。
