Schmidt Andrew H, Bosse Michael J, Frey Katherine P, OʼToole Robert V, Stinner Daniel J, Scharfstein Daniel O, Zipunnikov Vadim, MacKenzie Ellen J
*Department of Orthopaedic Surgery, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN; †Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC; ‡Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; §R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore MD; ‖Department of Orthopaedics, San Antonio Military Medical Center, US Army Institute of Surgical Research, San Antonio, TX; ¶Centre for Blast Injury Studies, Imperial College London, London, United Kingdom; and **Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Orthop Trauma. 2017 Apr;31 Suppl 1:S40-S47. doi: 10.1097/BOT.0000000000000796.
The diagnosis of acute compartment syndrome (ACS) is a common clinical challenge among patients who sustain high-energy orthopaedic trauma, largely because no validated criteria exist to reliably define the presence of the condition. In the absence of validated diagnostic standards, concern for the potential clinical and medicolegal impact of a missed compartment syndrome may result in the potential overuse of fasciotomy in "at-risk" patients. The goal of the Predicting Acute Compartment Syndrome Study was to develop a decision rule for predicting the likelihood of ACS that would reduce unnecessary fasciotomies while guarding against potentially missed ACS. Of particular interest was the utility of early and continuous monitoring of intramuscular pressure and muscle oxygenation using near-infrared spectroscopy in the timely diagnosis of ACS. In this observational study, 191 participants aged 18-60 with high-energy tibia fractures were prospectively enrolled and monitored for up to 72 hours after admission, then followed for 6 months. Treating physicians were blinded to continuous pressure and oxygenation data. An expert panel of 9 orthopaedic surgeons retrospectively assessed the likelihood that each patient developed ACS based on data collected on initial presentation, clinical course, and known functional outcome at 6 months. This retrospectively assigned likelihood is modeled as a function of clinical data typically available within 72 hours of admission together with continuous pressure and oxygenation data. This study will improve our understanding of the natural history of compartment syndrome and examine the utility of early and continuous monitoring of the physiologic status of the injured extremity in the timely diagnosis of ACS.
对于遭受高能骨科创伤的患者而言，急性骨筋膜室综合征（ACS）的诊断是一项常见的临床挑战，主要原因是目前尚无经过验证的标准来可靠地界定该病症的存在。在缺乏经过验证的诊断标准的情况下，由于担心漏诊骨筋膜室综合征可能产生的临床和法医学影响，可能会导致在“高危”患者中过度使用筋膜切开术。预测急性骨筋膜室综合征研究的目标是制定一项决策规则，用于预测ACS的发生可能性，以减少不必要的筋膜切开术，同时防止可能漏诊的ACS。特别令人感兴趣的是，利用近红外光谱技术对肌肉内压力和肌肉氧合进行早期和持续监测在ACS及时诊断中的效用。在这项观察性研究中，前瞻性纳入了191名年龄在18至60岁之间、患有高能胫骨骨折的参与者，并在入院后对其进行长达72小时的监测，然后随访6个月。治疗医生对连续的压力和氧合数据不知情。一个由9名骨科外科医生组成的专家小组根据初始表现、临床病程以及6个月时已知的功能结局所收集的数据，对每位患者发生ACS的可能性进行了回顾性评估。这种回顾性确定的可能性被建模为入院72小时内通常可获得的临床数据以及连续压力和氧合数据的函数。这项研究将增进我们对骨筋膜室综合征自然病程的理解，并检验对受伤肢体生理状态进行早期和持续监测在ACS及时诊断中的效用。
