Tam J P H, Gibson A G F, Murray J R D, Hassaballa M
Faculty of Health Sciences, University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK.
Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK.
Eur J Orthop Surg Traumatol. 2019 Feb;29(2):479-485. doi: 10.1007/s00590-018-2299-3. Epub 2018 Aug 25.
Chronic exertional compartment syndrome (CECS) is an overuse disorder typically affecting an athletic population. CECS is a diagnosis based on history and intracompartmental pressure (ICP) testing. CECS patients can be treated surgically by fasciotomy; however, research on the relationship between ICP and patient symptoms and also between ICP and patient-reported outcome post-fasciotomy is limited. This study aims to (1) assess functional outcome and patient satisfaction post-fasciotomy and (2) identify any potential correlation between ICP and reported levels of pain.
138 CECS patients who had ICP measurements and subsequently underwent fasciotomy were identified from our regional service for exercise-induced lower limb extremity pain between January 2000 and March 2017. Clinical outcomes were recorded at the time of ICP testing and in the post-operative follow-up clinic. Pain was reported using a verbal rating scale (VRS) ('low', 'moderate' or 'high') or as a visual analogue score (VAS) 0-10 (0 = least painful, 10 = most painful). Spearman's ranked correlation test was used to calculate correlation between ICP and reported pain.
A total of 138 patients were eligible for inclusion in this study (mean age 29.7 ± 9.7 years, 110 M, 28 F) of which 109 patients (VRS n = 61, VAS n = 48) reported pain level at pre- and post-operative stages. Mean pre-operative VAS score was 8.52 ± 0.71, and decreased to 0.77 ± 0.69 post-operatively. An insignificant positive correlation (r = 0.046, two-tailed p = 0.76) was found between VAS pain and ICP. A significant moderate positive correlation (r = 0.497, two-tailed p = 0.01) was found between VRS pain and ICP.
Fasciotomy significantly reduces pain and increases activity levels in CECS patients. ICP was found to positively correlate with patient-reported pain.
慢性运动性骨筋膜室综合征（CECS）是一种过度使用性疾病，通常影响运动员群体。CECS是一种基于病史和骨筋膜室内压力（ICP）测试的诊断。CECS患者可通过筋膜切开术进行手术治疗；然而，关于ICP与患者症状之间以及ICP与筋膜切开术后患者报告的预后之间关系的研究有限。本研究旨在（1）评估筋膜切开术后的功能预后和患者满意度，以及（2）确定ICP与报告的疼痛水平之间是否存在任何潜在相关性。
从2000年1月至2017年3月期间我们地区针对运动引起的下肢疼痛的服务中，识别出138例进行了ICP测量并随后接受筋膜切开术的CECS患者。在ICP测试时和术后随访门诊记录临床结果。使用语言评定量表（VRS）（“低”、“中”或“高”）或视觉模拟评分（VAS）0-10（0 = 最不痛，10 = 最痛）报告疼痛情况。使用Spearman等级相关检验计算ICP与报告疼痛之间的相关性。
共有138例患者符合纳入本研究的条件（平均年龄29.7±9.7岁，男性110例，女性28例），其中109例患者（VRS法n = 61例，VAS法n = 48例）报告了术前和术后阶段的疼痛水平。术前VAS平均评分为8.52±0.71，术后降至0.77±0.69。VAS疼痛与ICP之间发现无显著正相关（r = 0.046，双侧p = 0.76）。VRS疼痛与ICP之间发现显著的中度正相关（r = 0.497，双侧p = 0.01）。
筋膜切开术可显著减轻CECS患者的疼痛并提高活动水平。发现ICP与患者报告的疼痛呈正相关。
