Vogels Sanne, VAN Ark Wendela, Janssen Loes, Scheltinga Marc R M
Department of Surgery, Máxima MC, Veldhoven, THE NETHERLANDS.
Med Sci Sports Exerc. 2021 Aug 1;53(8):1549-1554. doi: 10.1249/MSS.0000000000002631.
This study aimed to determine whether a fasciectomy for recurrent chronic exertional compartment syndrome of the anterior leg (ant-CECS) after a minimally invasive fasciotomy is safe and beneficial.
Demographics and clinical course of patients undergoing a fasciectomy for ongoing exercise-related leg pain (ERLP) after an earlier minimally invasive fasciotomy for ant-CECS were prospectively obtained using questionnaires. Patient-reported severity and frequency of pain, tightness, weakness, cramping, and paresthesia in rest and during exercise were scored before and after surgery. A successful outcome was defined as a self-reported good or excellent result.
Between January 2013 and March 2019, 24 of the 958 patients evaluated for ERLP were included in the study (15 females; median age, 24 yr; range, 14-37 yr). Intracompartmental pressure values before the minimally invasive fasciotomy and before the fasciectomy were not different. Perioperative findings were fibrotic bands, pseudofascias, or complete fusions of fascial edges. Postoperative superficial wound infections requiring oral antibiotics occurred in four legs. After rehabilitation, the total symptom scores during exercise and resting conditions decreased threefold compared with preoperatively (exercise, 55 ± 5 to 17 ± 3, P < 0.001; rest, 30 ± 4 to 10 ± 2, P < 0.001). All cardinal symptoms decreased significantly, but the largest improvements were reported for pain and tightness. At follow-up (median, 12 months; range, 2-65 months), 79% of patients reported a successful outcome, whereas 75% had returned to physical activity.
An anterior fasciectomy with associated treatment of correlated pathologies can be safe and beneficial in patients with ongoing ERLP who previously underwent a minimally invasive fasciotomy for ant-CECS.
本研究旨在确定在前臂慢性运动性骨筋膜室综合征（ant-CECS）微创筋膜切开术后进行筋膜切除术是否安全且有益。
通过问卷调查前瞻性地获取了在先前因ant-CECS进行微创筋膜切开术后因持续性运动相关腿痛（ERLP）而接受筋膜切除术患者的人口统计学和临床病程。在手术前后对患者报告的休息和运动时疼痛、紧绷、无力、抽筋和感觉异常的严重程度和频率进行评分。成功的结果定义为自我报告的良好或优秀结果。
在2013年1月至2019年3月期间，958例接受ERLP评估的患者中有24例纳入本研究（15例女性；中位年龄24岁；范围14 - 37岁）。微创筋膜切开术前和筋膜切除术前的骨筋膜室内压力值无差异。围手术期发现有纤维化带、假筋膜或筋膜边缘完全融合。4条腿出现需要口服抗生素治疗的术后浅表伤口感染。康复后，运动和休息状态下的总症状评分与术前相比降低了三倍（运动时，55±5降至17±3，P<0.001；休息时，30±4降至10±2，P<0.001）。所有主要症状均显著减轻，但疼痛和紧绷的改善最为明显。在随访（中位时间12个月；范围2 - 65个月）时，79%的患者报告结果成功，而75%的患者已恢复体育活动。
对于先前因ant-CECS接受微创筋膜切开术且仍有持续性ERLP的患者，进行前路筋膜切除术及相关病理的治疗可能是安全且有益的。
