前间隔腿部综合征的尸体模型：皮下微创筋膜切开术与开放性筋膜切开术。

A cadaveric model of anterior compartment leg syndrome: Subcutaneous minimally invasive fasciotomy versus open fasciotomy.

机构信息

Pôle de morphologie, institut de recherche expérimentale et clinique, université catholique de Louvain, avenue Mounier 52 bte B1.52.04, 1200 Brussels, Belgium; Service de chirurgie orthopédique et traumatologique, cliniques universitaires Saint-Luc, 10, avenue Hippocrate, 1200 Brussels, Belgium.

Pôle de morphologie, institut de recherche expérimentale et clinique, université catholique de Louvain, avenue Mounier 52 bte B1.52.04, 1200 Brussels, Belgium.

出版信息

Orthop Traumatol Surg Res. 2019 Feb;105(1):167-171. doi: 10.1016/j.otsr.2018.10.003. Epub 2018 Nov 22.

DOI:10.1016/j.otsr.2018.10.003

PMID:30471925

Abstract

OBJECTIVE

Because of disabling sequelae of open fasciotomy in anterior compartment syndrome (ACS) of the leg, we wanted to describe and validate a cadaveric model of ACS. We hypothesized that, first, anterior compartment syndrome (ACS) could be reproduced in cadaveric leg and, second, fasciotomy without complete skin incision could lower the intramuscular pressure (IMP) in an equivalent range to complete dermatofasciotomy.

MATERIALS AND METHODS

Lower limb ACS was reproduced by progressive injection of physiologic serum in the anterior compartment of 23 fresh frozen cadaveric legs with monitoring of IMP, in order to reach a maximal stabilised IMP higher than 30mmHg. Subcutaneous minimally invasive fasciotomy was performed on 14 legs through 5 transversal mini-incisions of the skin (2cm) along the axis from the tibial tuberosity to the posterior aspect of the lateral malleolus. Standard open fasciotomy of the anterior compartment was performed on the remaining 9 legs as control. IMP was measured after the skin incisions and after every fasciotomy through skin incisions in the first group and after skin and fascia incisions in the control group.

RESULTS

A maximal IMP of 43±2mmHg was obtained by injection of 177±9ml physiologic serum into the anterior compartment of the leg. In the control open fasciotomy group, the skin incision alone did not lower IMP significantly, whereas fasciotomy lowered IMP to 10±1mmHg, which is statistically different from maximal IMP (p<0.001). In the subcutaneous fasciotomy group, complete fasciotomy lowered significantly the IMP to 11±4mmHg (p<0.001), without statistical difference with the control group.

DISCUSSION

This cadaveric model is effective to reproduce the hyperpressure encountered in ACS. In this model, IMP release after fasciotomy is as efficient through minimally invasive subcutaneous incision as with control open fasciotomy. This in vitro technique appears as an attractive alternative treatment in anterior compartment syndrome of the leg. It should be tested in the other compartments of the leg and its in vivo feasibility in acute conditions has to be clarified.

LEVEL OF EVIDENCE

III, control laboratory study.

摘要

目的

由于开放性筋膜切开术在腿部前间室综合征（ACS）中的致残后遗症，我们希望描述并验证一种 ACS 的尸体模型。我们假设，首先，ACS 可以在尸体腿部重现，其次，不进行完整皮肤切开的筋膜切开术可以将肌肉内压（IMP）降低到与完整皮肤切开术相当的范围。

材料和方法

通过在前间室中逐渐注入生理血清，在 23 个新鲜冷冻尸体腿部中复制下肢 ACS，并监测 IMP，以达到高于 30mmHg 的稳定最大 IMP。通过沿着胫骨结节到外踝后侧面的轴线进行 5 个皮肤的横向微创筋膜切开术，对 14 条腿进行皮下微创筋膜切开术。剩余的 9 条腿作为对照进行标准的前间室开放性筋膜切开术。在第一组中，通过皮肤切口进行筋膜切开术和皮肤切口后测量 IMP，在对照组中，通过皮肤和筋膜切口进行筋膜切开术和皮肤切口后测量 IMP。

结果

通过在前间室注射 177±9ml 生理血清，获得了 43±2mmHg 的最大 IMP。在对照组的开放性筋膜切开术中，单独的皮肤切口并不能显著降低 IMP，而筋膜切开术将 IMP 降低至 10±1mmHg，与最大 IMP 有统计学差异（p<0.001）。在皮下筋膜切开术组中，完全筋膜切开术显著降低 IMP 至 11±4mmHg（p<0.001），与对照组无统计学差异。