Barrera-Ochoa Sergi, Correa-Vazquez Eva, Gallardo-Calero Irene, Haddad Sleiman, Sallent Andrea, Soldado Francisco, Campillo-Recio David, Mir-Bullo Xavier
Orthopedic Surgery Department, Pediatric Upper Extremity Surgery and Microsurgery, Hospital Sant Joan De Deu, Barcelona, Spain.
Hand and Upper Extremity Unit, ICATME-Institut Català de Traumatologia i Medicina de l'Esport. Institut Universitari Dexeus, Barcelona, Spain.
Clin J Sport Med. 2018 Nov;28(6):516-523. doi: 10.1097/JSM.0000000000000482.
To measure the accuracy of currently used intracompartmental pressure (ICP) diagnostic variables for forearm chronic exertional compartment syndrome (CECS) and a new ICP diagnostic variable, TRest, the recovery time between the maximum ICP and return to resting pressure.
Retrospective cohort. Level evidence IV.
University-affiliated tertiary hospital.
Patients with suspected forearm CECS, 1990 to 2014.
All patients underwent physical examination and exertional stress test, preceded and followed by measuring ICP in all suspicious CECS. Surgery was proposed when indicated. Minimum follow-up was 18 months. Final diagnosis was established at the final follow-up.
Intracompartmental pressure measurements: PRest (baseline/pre-exercise pressure), P1 min (pressure 1 minute after exercise), P5 min (pressure 5 minutes after exercise), and TRest. Patients rated their pain and completed Quick-DASH in all follow-ups. Patients ultimately were classified into 4 groups (true positives, true negatives, false positives, and false negatives) for each ICP measurement relative to the final diagnosis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
A total of 124 male athletes were diagnosed with CECS, 27 bilateral. Accuracy with standard ICP diagnostic variables was lower (sensitivity 73.5%, specificity 84.2%, positive predictive value 97%, and negative predictive value 31.4%) than with TRest (SN 100%, SP 94.7%, PPV 99.3%, and NPV 100%); 23% of patients would have been missed following the standard ICP diagnostic criteria.
Diagnostic thresholds for current standard ICP measurements should be lowered. TRest, a new measure, might be more accurate.
测量当前用于诊断前臂慢性运动性骨筋膜室综合征（CECS）的骨筋膜室内压力（ICP）诊断变量以及一个新的ICP诊断变量TRest（即最大ICP与恢复至静息压力之间的恢复时间）的准确性。
回顾性队列研究。证据等级为IV级。
大学附属三级医院。
1990年至2014年疑似前臂CECS的患者。
所有患者均接受体格检查和运动应激试验，在所有疑似CECS部位测量ICP前后进行。有指征时建议手术。最短随访时间为18个月。在最终随访时确立最终诊断。
骨筋膜室内压力测量值：PRest（基线/运动前压力）、P1min（运动后1分钟压力）、P5min（运动后5分钟压力）和TRest。患者在所有随访中对疼痛进行评分并完成快速DASH问卷。相对于最终诊断，每位患者最终根据每个ICP测量值被分为4组（真阳性、真阴性、假阳性和假阴性）。计算敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
共有124名男性运动员被诊断为CECS，其中27例为双侧。标准ICP诊断变量的准确性（敏感性73.5%，特异性84.2%，阳性预测值97%，阴性预测值31.4%）低于TRest（敏感性100%，特异性94.7%，阳性预测值99.3%，阴性预测值100%）；按照标准ICP诊断标准，23%的患者会被漏诊。
当前标准ICP测量的诊断阈值应降低。新指标TRest可能更准确。
