胫骨骨干骨折后骨间室压力与骨骼肌恢复之间的关系：一项前瞻性队列研究。

The association between intracompartmental pressure and skeletal muscle recovery after tibial diaphyseal fractures: an ambispective cohort study.

机构信息

Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, No. 450, Teng Yue Road, Yangpu District, Shanghai, 200090, People's Republic of China.

Department of Emergency Traumatic Surgery, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, China.

出版信息

J Orthop Traumatol. 2021 May 6;22(1):18. doi: 10.1186/s10195-021-00579-7.

DOI:10.1186/s10195-021-00579-7

PMID:33959802

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8102659/

Abstract

BACKGROUND

Due to the special anatomy of the lower leg, tibial diaphyseal fracture causes increased intracompartmental pressure (ICP). Not only is this increased ICP the manifestation of skeletal muscle injury, but it induces further deterioration of the injury. The aim of this study was to assess the association between short-term ICP elevation and long-term skeletal muscle recovery after severe limb trauma.

METHODS

In this single-center ambispective cohort study, we retrospectively screened and recruited a cohort of tibial diaphyseal fracture patients with integrated ICP data during the early post-traumatic period, and performed a prospective observational study to evaluate their skeletal muscle recovery through long-term follow-up and MR imaging after the removal of the implants. We analyzed the association between ICP elevation and skeletal muscle recovery using statistical methods.

RESULTS

A total of 46 patients with healed fractures underwent intramedullary nail removal and MR imaging. The absolute values of the Pearson product-moment correlation coefficients between various ICP parameters and the cross-sectional area ratio (CSAR) ranged from 0.588 to 0.793, and the correlation coefficients between the ICP parameters and the average T2-weighted signal intensity ratio (T2SIR) varied from 0.566 to 0.775. Statistically significant associations were observed between the ICP parameters and the MR imaging parameters when simple linear regression analysis was performed. Among the ICP parameters, the accumulated ΔP (ΔP = diastolic blood pressure minus ICP) had the highest determination coefficient and explained 62.1% and 59.1% of the variance in CSAR and T2SIR, respectively.

CONCLUSIONS

Short-term ICP elevation was associated with long-term skeletal muscle recovery following tibial diaphyseal fracture, especially for ICP data that integrated time factors.

LEVEL OF EVIDENCE

Level 3.

摘要

背景

由于小腿的特殊解剖结构，胫骨骨干骨折会导致筋膜室内压力（ICP）升高。这种升高的 ICP 不仅是骨骼肌损伤的表现，还会导致损伤进一步恶化。本研究旨在评估严重肢体创伤后短期 ICP 升高与长期骨骼肌恢复之间的关系。

方法

在这项单中心前瞻性队列研究中，我们回顾性筛选并招募了一组在创伤后早期有 ICP 数据整合的胫骨骨干骨折患者，并通过长期随访和植入物去除后的磁共振成像（MRI）进行前瞻性观察研究，以评估他们的骨骼肌恢复情况。我们使用统计方法分析了 ICP 升高与骨骼肌恢复之间的关系。

结果

共有 46 例骨折愈合的患者接受髓内钉取出和 MRI 检查。各 ICP 参数与横截面积比（CSAR）的 Pearson 积矩相关系数绝对值范围为 0.588 至 0.793，ICP 参数与平均 T2 加权信号强度比（T2SIR）的相关系数范围为 0.566 至 0.775。当进行简单线性回归分析时，观察到 ICP 参数与 MRI 参数之间存在显著的相关性。在 ICP 参数中，累积 ΔP（ΔP=舒张压减去 ICP）具有最高的决定系数，分别解释了 CSAR 和 T2SIR 方差的 62.1%和 59.1%。