Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, C/Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Spain.
Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès (Barcelona), Spain.
Surg Radiol Anat. 2023 Dec;45(12):1603-1617. doi: 10.1007/s00276-023-03242-4. Epub 2023 Oct 9.
Compartment syndrome is a surgical emergency that can occur in any part of the body and can cause cell necrosis when maintained over time. The resulting defects can affect the nerves, muscle cells, bone tissue, and other connective tissues inside the compartment, and fasciotomy has to be performed. The anatomical and histological characteristics of the leg make acute, chronic, and exertional compartment syndrome more likely in this limb. For these reasons, knowledge of the ultrasound, anatomical, and histological features of the crural fascia can help in the treatment of leg compartment syndrome.
Twenty-one cryopreserved lower limbs from adult cadavers and from one 29-week-old fetus were obtained from the dissection room. They were examined by ultrasound and a subsequent anatomical dissection and microscopy to study the crural fascia and its relationship with the different muscles. Anthropometric measurements were taken of the distances from the head of the fibula and lateral malleolus to the origin of the tibialis anterior muscle in the crural fascia, the exit of the superficial fibular nerve, and the fascia covering the deep posterior muscles of the leg.
The crural fascia has very important clinical relationships, which can be identified by ultrasound, as the origin of the tibialis anterior muscle at 16.25 cm from the head of the fibula and the exit of the superficial fibular nerve that crosses this fascia at 21.25 cm from the head of the fibula. Furthermore, the presence of a septum that fixes the deep posterior muscles of the leg and the vessels and nerve can be seen by ultrasound and can explain the possible development of a posterior compartmental syndrome of the leg. Awareness of these features will help to keep these structures safe during the surgical treatment of compartment syndrome.
The ultrasound study allows identification of anatomical structures in the leg and, thus, avoids damage to them during surgery for compartmental syndromes.
筋膜室综合征是一种可发生于身体任何部位的外科急症，如果长时间得不到治疗，会导致细胞坏死。由此产生的缺陷会影响到筋膜室内的神经、肌肉细胞、骨组织和其他结缔组织，此时必须进行筋膜切开术。腿部的解剖和组织学特征使得急性、慢性和运动性筋膜室综合征在该肢体中更易发生。出于这些原因，了解小腿筋膜的超声、解剖和组织学特征有助于治疗腿部筋膜室综合征。
从解剖室获得了 21 个来自成人尸体和一个 29 周大胎儿的冷冻下肢。通过超声检查以及随后的解剖和显微镜检查来研究小腿筋膜及其与不同肌肉的关系。对小腿筋膜中腓骨头和外踝到胫骨前肌起点的距离、腓浅神经出口以及覆盖小腿深层后肌的筋膜进行了人体测量。
小腿筋膜具有非常重要的临床关系，可以通过超声来识别，如胫骨前肌的起点在腓骨头 16.25cm 处，腓浅神经穿过筋膜的出口在腓骨头 21.25cm 处。此外，通过超声可以看到固定小腿深层后肌和血管、神经的间隔，这可以解释小腿后筋膜室综合征的可能发展。了解这些特征将有助于在筋膜室综合征的手术治疗中保护这些结构。
超声研究可以识别腿部的解剖结构，从而避免在手术治疗筋膜室综合征时损伤这些结构。
