van Zantvoort Aniek P M, de Bruijn Johan A, Winkes Michiel B, Hoogeveen Adwin R, Teijink Joep A W, Scheltinga Marc R
Department of Surgery, Máxima Medical Center, Eindhoven/Veldhoven, the Netherlands.
Caphri Research School, Maastricht University, Maastricht, the Netherlands.
Orthop J Sports Med. 2017 Jun 9;5(6):2325967117711121. doi: 10.1177/2325967117711121. eCollection 2017 Jun.
The diagnostic gold standard for diagnosing chronic exertional compartment syndrome (CECS) is a dynamic intracompartmental pressure (ICP) measurement of the muscle. The potential role of a repeat ICP (re-ICP) measurement in patients with persistent lower leg symptoms after surgical decompression or with ongoing symptoms after an earlier normal ICP is unknown.
To study whether re-ICP measurements in patients with persistent CECS-like symptoms of the lower leg may contribute to the diagnosis of CECS after both surgical decompression and a previously normal ICP measurement.
Case series; Level of evidence, 4.
Charts of patients who underwent re-ICP measurement of lower leg compartments (anterior [ant], deep posterior [dp], and/or lateral [lat] compartments) between 2001 and 2013 were retrospectively studied. CECS was diagnosed on the basis of generally accepted cutoff pressures for newly onset CECS (Pedowitz criteria: ICP at rest ≥15 mmHg, ≥30 mmHg after 1 minute, or ≥20 mmHg 5 minutes after a provocative test). Factors predicting recurrent CECS after surgery or after a previously normal ICP measurement were analyzed.
A total of 1714 ICP measurements were taken in 1513 patients with suspected CECS over a 13-year observation period. In all, 201 (12%) tests were re-ICP measurements for persistent lower leg symptoms. Based on the proposed ICP cutoff values, CECS recurrence was diagnosed in 16 of 62 previously operated compartments (recurrence rate, 26%; 53 patients [64% female]; median age, 24 years; age range, 15-78 years). Recurrence rates were not different among the 3 lower leg CECS compartments (ant-CECS, 17%; dp-CECS, 33%; lat-CECS, 30%; χ = 1.928, = .381). Sex (χ = 0.058, = .810), age ( = 378, = 1.840, = .066), bilaterality (χ = 0.019, = .889), and prefasciotomy ICP did not predict recurrence. Re-ICP measurements evaluating 20 compartments with previously normal ICP measurements (15 patients [53% female]; mean age, 31 ± 10 years) detected CECS in 3 compartments (15%, all ant-CECS).
Previous fasciotomy for lower leg CECS or previously normal muscle pressure (ICP) do not rule out CECS as a cause of persisting lower leg symptoms. Repeat ICP measurement may have a potential role in the evaluation of patients with persistent lower leg complaints. However, other reasons for lower leg exertional pain must always be considered prior to secondary surgery.
诊断慢性运动性骨筋膜室综合征（CECS）的金标准是对肌肉进行动态骨筋膜室内压力（ICP）测量。对于手术减压后仍有小腿症状的患者或早期ICP正常但仍有症状的患者，重复进行ICP（re - ICP）测量的潜在作用尚不清楚。
研究小腿持续出现类似CECS症状的患者进行re - ICP测量是否有助于在手术减压后以及先前ICP测量正常后诊断CECS。
病例系列；证据等级，4级。
回顾性研究2001年至2013年间接受小腿骨筋膜室（前侧[ant]、深后侧[dp]和/或外侧[lat]骨筋膜室）re - ICP测量的患者病历。根据新发性CECS普遍接受的临界压力（佩多维茨标准：静息时ICP≥15 mmHg，1分钟后≥30 mmHg，或激发试验后5分钟≥20 mmHg）诊断CECS。分析预测手术后或先前ICP测量正常后CECS复发的因素。
在13年的观察期内，对1513例疑似CECS患者共进行了1714次ICP测量。其中，201次（12%）测试是针对小腿持续症状进行的re - ICP测量。根据提议的ICP临界值，在62个先前接受手术的骨筋膜室中有16个诊断为CECS复发（复发率为26%；53例患者[64%为女性]；中位年龄24岁；年龄范围15 - 78岁）。小腿3个CECS骨筋膜室的复发率无差异（前侧CECS，17%；深后侧CECS，33%；外侧CECS，30%；χ² = 1.928，P = 0.381）。性别（χ² = 0.058，P = 0.810）、年龄（P = 0.378，t = 1.840，P = 0.066）、双侧性（χ² = 0.019，P = 0.889）和术前筋膜切开术时的ICP均不能预测复发。对20个先前ICP测量正常的骨筋膜室进行re - ICP测量（15例患者[53%为女性]；平均年龄31±10岁），在3个骨筋膜室中检测到CECS（15%，均为前侧CECS）。
先前因小腿CECS进行的筋膜切开术或先前正常的肌肉压力（ICP）并不能排除CECS是小腿持续症状的原因。重复进行ICP测量可能在评估小腿持续不适的患者中具有潜在作用。然而，在进行二次手术之前，必须始终考虑小腿运动性疼痛的其他原因。
