Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Hospital, London, United Kingdom.
J Vasc Surg. 2020 Nov;72(5):1802-1812. doi: 10.1016/j.jvs.2020.05.030. Epub 2020 May 27.
Chronic exertional compartment syndrome (CECS) is an overuse injury typically seen in young and athletic patients. The five cardinal symptoms are pain, tightness, cramping, weakness, and paresthesia. These classically occur during exertion and disappear with cessation of the activity, with no permanent damage to tissues within the compartment; nonetheless, CECS presents a significant functional impairment to those affected. Regulating exercise has been shown to alleviate symptoms, but this may not be acceptable to some patients (eg, professional athletes). For patients who fail to respond to conservative management or where exercise reduction is unrealistic, fasciotomy can be considered. There are no established guidelines on the management of CECS, and it remains underdiagnosed. The aim of this systematic review was to compare the outcomes of patients suffering from CECS managed with either fasciotomy or nonoperative means by examining functional outcomes and resolution of symptoms.
MEDLINE and Embase databases and clinical trial registries were searched comprehensively; 219 articles were identified, and 14 articles were included in the systematic review. Given the heterogeneity between the studies in terms of outcomes reported, a qualitative synthesis was performed.
The majority of included studies were retrospective cohort studies, with a single prospective cohort study. Studies included fasciotomies performed in the upper and lower limbs. The population of patients included military servicemen, motocross racers, and unselected patients. There is insufficient evidence in the literature to support conservative or surgical management over the other in the management of CECS. However, fasciotomy appears to be a safe approach, with satisfaction rates of 48% to 94%. Complications related to the fasciotomy included hematomas (2.7%-22.5%), nerve injuries (2.0%-18.6%), deep venous thrombosis (2.7%), and symptom recurrence (0.65%-8.4%). Up to 10.4% of patients required revision fasciotomy.
There is no consensus on the optimal management of CECS and, as yet, no established international guidelines on treatment. This systematic review suggests that fasciotomy could be a safe and viable option in the management of patients suffering from CECS, with promising long-term results. Future research in the form of randomized controlled trials comparing conservative and surgical management would be beneficial.
慢性运动性间隔综合征（CECS）是一种常见于年轻运动员的过度使用损伤。五个主要症状是疼痛、紧绷、抽筋、无力和感觉异常。这些症状通常在运动时出现，停止运动后消失，不会对间隔内的组织造成永久性损伤；然而，CECS 会对受影响的人造成显著的功能障碍。已经证明，调节运动可以缓解症状，但这对某些患者（例如职业运动员）可能不可接受。对于那些对保守治疗无反应或减少运动不切实际的患者，可以考虑筋膜切开术。目前尚无关于 CECS 管理的既定指南，而且该病的诊断不足。本系统评价的目的是通过检查功能结果和症状缓解情况，比较接受筋膜切开术或非手术治疗的 CECS 患者的结果。
全面检索了 MEDLINE 和 Embase 数据库以及临床试验登记处；确定了 219 篇文章，其中 14 篇文章纳入了系统评价。由于研究之间报告的结果存在异质性，因此进行了定性综合分析。
大多数纳入的研究是回顾性队列研究，仅有一项前瞻性队列研究。研究包括在上肢和下肢进行的筋膜切开术。患者人群包括军人、越野摩托车赛车手和未选择的患者。文献中没有足够的证据支持 CECS 的保守或手术治疗优于另一种治疗方法。然而，筋膜切开术似乎是一种安全的方法，满意度为 48%至 94%。与筋膜切开术相关的并发症包括血肿（2.7%-22.5%）、神经损伤（2.0%-18.6%）、深静脉血栓形成（2.7%）和症状复发（0.65%-8.4%）。多达 10.4%的患者需要进行筋膜切开术修正。
目前对于 CECS 的最佳治疗方法尚无共识，也没有关于治疗的既定国际指南。本系统评价表明，筋膜切开术可能是治疗 CECS 患者的一种安全可行的选择，具有良好的长期效果。未来进行比较保守治疗和手术治疗的随机对照试验的研究将是有益的。
