From the US Army Institute of Surgical Research (T.J.W., M.A.K., K.L.R.), Fort Sam Houston, San Antonio, Texas; and Department of Orthopaedic Surgery, Altman Clinical and Translational Research Institute (A.R.H.), University of California San Diego, San Diego, California.
J Trauma Acute Care Surg. 2019 Jul;87(1S Suppl 1):S59-S66. doi: 10.1097/TA.0000000000002284.
Acute compartment syndrome (ACS) is a serious medical condition that can occur following traumatic injury to an extremity. If left undiagnosed, ACS can eventuate in amputation of the limb or even death. Because of this, fasciotomy to release the pressure within the muscle and restore tissue perfusion is often performed upon suspicion of ACS, as the sequelae to fasciotomy are less severe than those associated with not performing the fasciotomy. Currently, the "gold standard" of diagnosis is based on clinical assessment of such symptoms as pain out of proportion to the injury, obvious high pressure and swelling, pain on passive stretch of the muscles in the affected compartment, and deficits in sensory and/ormotor functions. Diagnosis is often confirmed using invasive measurements of intramuscular pressure (IMP); however, controversy exists as to how direct IMP measurement should be accomplished and threshold pressures for accurate diagnosis. Because of this and the attendant issues with invasive measurements, investigators have been searching over the last 25 years for a noninvasive means to quantitatively measure IMP or perfusion to the limb. The purpose of this review is to summarize the current state of the art of noninvasive devices that could potentially be used to diagnose ACS accurately and objectively. To do this, we divide the discussion into those medical devices that primarily measure mechanical surrogates of IMP (e.g., tissue hardness or myofascial displacement) and those that primarily measure indices of tissue perfusion (e.g., tissue oxygen saturation via near-infraredspectroscopy). While near-infrared spectroscopy-basedtechnologies have shown the most promise, whether such technologies will be of diagnostic benefit await the completion of ongoing clinical trials. LEVEL OF EVIDENCE: Systematic Review, level II.
急性间隔综合征（ACS）是一种严重的医学病症，可能在四肢创伤后发生。如果不进行诊断，ACS 可能导致肢体截肢甚至死亡。因此，一旦怀疑 ACS，通常会进行筋膜切开术以释放肌肉内的压力并恢复组织灌注，因为筋膜切开术的后遗症比不进行筋膜切开术的后遗症要轻。目前，基于对疼痛与损伤不成比例、明显高压和肿胀、受影响间隔内肌肉被动伸展时疼痛以及感觉和/或运动功能缺陷等症状的临床评估，是诊断 ACS 的“金标准”。诊断通常通过肌肉内压力（IMP）的侵入性测量来确认；然而，如何直接进行 IMP 测量以及准确诊断的阈值压力存在争议。由于这一点以及侵入性测量的相关问题，研究人员在过去 25 年中一直在寻找一种非侵入性方法来定量测量 IMP 或肢体灌注。本综述的目的是总结目前可用于准确和客观诊断 ACS 的非侵入性设备的最新技术。为此，我们将讨论分为主要测量 IMP 的机械替代物（例如组织硬度或筋膜位移）的医疗设备和主要测量组织灌注指数（例如，通过近红外光谱测量组织氧饱和度）的医疗设备。尽管基于近红外光谱技术的技术显示出最大的潜力，但这些技术是否具有诊断益处，还需要等待正在进行的临床试验的完成。证据水平：系统评价，II 级。
