Sellei R M, Hingmann S J, Weber C, Jeromin S, Zimmermann F, Turner J, Hildebrand F, Pape H-C
Department of Orthopaedic Trauma, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Germany.
Department of Orthopaedic Trauma, Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany.
Eur J Trauma Emerg Surg. 2015 Dec;41(6):639-45. doi: 10.1007/s00068-014-0449-9. Epub 2014 Sep 25.
There is a risk of misinterpreting the clinical signs of acute compartment syndrome of the lower limb resulting in delayed fasciotomy. Up to date, the diagnosis of compartment syndrome is based on clinical assessment and of invasive needle pressure measurement in uncertain cases. Close monitoring is necessary for early recognition of raising compartment pressures. Clinical assessment of muscle firmness by the physician's palpation alone is unreliable. Thus, a device objectifying this assessment would be beneficial. The purpose of this study was to determine the feasibility of muscle compartment elasticity measurements by a novel and non-invasive device using pressure-related ultrasound.
In a cadaveric model, the anterior tibial compartment was prepared to simulate raising intra-compartmental pressures (0-80 mmHg) by saline infusion. Standard invasive pressure monitoring was compared with a novel method to determine tissue elasticity. Changing cross-sectional view in B-mode ultrasound was exerted to measure the compartment depth before and after physician's probe compression of 100 mmHg. Compartment displacement (∆d) was measured and related to the corresponding compartmental pressure (Spearman correlation coefficient). Delta (mm) of the control group at 10 mmHg compartment pressure was compared with measured data at rising compartmental pressures of 30, 50, and 70 mmHg using the Wilcoxon rank-sum test. The intra-observer reliability (κ) was additionally calculated.
Fresh and never frozen lower human limbs (n = 6) were used. The average displacement measured in the anterior tibial compartment was 2.7 mm (0.3-6.7 mm). A concordant consistent correlation between the compartmental displacement and the intra-compartmental pressure occurred. The Spearman coefficient (r s = 0.979) showed a significant correlation between the rising pressure and the decreasing tissue displacement visualized by ultrasound. The intra-observer value kappa showed reliable values (κ 10 = 0.73, κ 30 = 0.80, and κ 70 = 0.79).
We introduce a new method of ultrasound imaging enhanced with probe pressure measurement to determine changes of the visco-elastic behavior of isolated muscle compartments. Pressure-related ultrasound could be a reliable tool to determine the correlation between the measured compartmental displacement and the increasing intra-compartmental pressure. Its accuracy revealed promising results. This technique may help the physician to objectify the clinical assessment of compartment elasticity, mainly indicated in cases of unconscious patients and imminent pathology. Further clinical studies and improvements of this technique are required to prove its accuracy and reliability in cases of compartment syndrome.
存在误判下肢急性骨筋膜室综合征临床体征从而导致筋膜切开术延迟的风险。迄今为止，骨筋膜室综合征的诊断基于临床评估，在不确定的情况下还需进行有创针压测量。密切监测对于早期识别骨筋膜室内压力升高很有必要。仅靠医生触诊对肌肉硬度进行临床评估并不可靠。因此，一种能使这种评估客观化的设备将很有帮助。本研究的目的是确定使用与压力相关的超声的新型无创设备测量肌肉骨筋膜室弹性的可行性。
在尸体模型中，准备胫前骨筋膜室，通过注入生理盐水模拟骨筋膜室内压力升高（0 - 80 mmHg）。将标准有创压力监测与一种确定组织弹性的新方法进行比较。在B型超声中改变横截面视图，以测量医生用100 mmHg探头按压前后骨筋膜室深度。测量骨筋膜室位移（∆d）并将其与相应的骨筋膜室内压力相关联（斯皮尔曼相关系数）。使用威尔科克森秩和检验将对照组在10 mmHg骨筋膜室内压力时的∆d与骨筋膜室内压力升至30、50和70 mmHg时的测量数据进行比较。另外计算观察者内信度（κ）。
使用了新鲜且从未冷冻过的人体下肢（n = 6）。在胫前骨筋膜室测量的平均位移为2.7 mm（0.3 - 6.7 mm）。骨筋膜室位移与骨筋膜室内压力之间存在一致的相关性。斯皮尔曼系数（r s = 0.979）表明压力升高与超声显示的组织位移减小之间存在显著相关性。观察者内kappa值显示出可靠的值（κ 10 = 0.73，κ 30 = 0.80，κ 70 = 0.79）。
我们引入了一种通过探头压力测量增强的超声成像新方法，以确定孤立肌肉骨筋膜室粘弹性行为的变化。与压力相关的超声可能是确定测量的骨筋膜室位移与骨筋膜室内压力升高之间相关性的可靠工具。其准确性显示出有前景的结果。这项技术可能有助于医生客观化骨筋膜室弹性的临床评估，主要适用于无意识患者和即将出现病变的情况。需要进一步的临床研究和对该技术的改进，以证明其在骨筋膜室综合征病例中的准确性和可靠性。
