Womack Army Medical Center, Fort Liberty, NC.
Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD.
Med Sci Sports Exerc. 2024 Sep 1;56(9):1685-1693. doi: 10.1249/MSS.0000000000003471. Epub 2024 Apr 29.
Lower extremity chronic exertional compartment syndrome (LE-CECS) can limit rigorous physical activity, particularly in the US military, and fasciotomy is a potential treatment. Associations between LE-CECS, fasciotomy, and occupational outcomes appear understudied. We studied active-duty US service members to identify whether LE-CECS diagnoses and fasciotomy for LE-CECS predict military service separation.
We conducted a retrospective cohort study of 1,103,417 individuals who entered service during 2011 to 2017. Distributions of separation statuses and independent variables were tabulated, and sex-specific multivariable regression models were computed for separation outcomes.
LE-CECS was associated with a 474% medical service separation risk in men (95% confidence interval (CI) for adjusted risk ratio: 5.21 to 6.33) and a 282% increase in women (CI: 2.99 to 4.88). Among 1947 patients with LE-CECS, men saw a 57% nonmedical separation risk increase (CI: 1.27 to 1.93) and women had a 119% increase (CI: 1.10 to 4.35) when anterior and/or lateral compartment procedures occurred. Men with LE-CECS and any posterior procedures saw a 47% nonmedical separation risk increase (CI: 1.17 to 1.86). Men with anterior and/or lateral procedures and any posterior procedures experienced 36% (CI: 1.09 to 1.71) and 78% (CI: 1.40 to 2.26) medical separation risk increases, respectively. No statistically significant risk increases for the outcomes were otherwise seen for women.
LE-CECS was associated with increased military service discharge risks. Among the affected patients, positive effects on career longevity were not seen in association with fasciotomy. However, fasciotomy could simply serve as a marker of the most refractory cases that are least likely to continue service. More study is needed to clarify causal pathways and identify patients who may derive career benefits from surgical treatment.
下肢慢性运动性间隔综合征（LE-CECS）可限制剧烈的体力活动，尤其是在美国军队中，筋膜切开术是一种潜在的治疗方法。LE-CECS、筋膜切开术和职业结果之间的关联似乎研究不足。我们研究了现役美国军人，以确定 LE-CECS 诊断和 LE-CECS 筋膜切开术是否预测军事服务分离。
我们对 2011 年至 2017 年期间入伍的 1103417 名个体进行了回顾性队列研究。列出了分离状态和自变量的分布，并为分离结果计算了性别特异性多变量回归模型。
LE-CECS 与男性的医疗服务分离风险增加 474%（调整风险比的 95%置信区间：5.21 至 6.33）和女性增加 282%（CI：2.99 至 4.88）相关。在 1947 例 LE-CECS 患者中，男性非医疗分离风险增加 57%（CI：1.27 至 1.93），女性增加 119%（CI：1.10 至 4.35），当发生前侧和/或外侧间隔手术时。LE-CECS 伴任何后侧手术的男性非医疗分离风险增加 47%（CI：1.17 至 1.86）。接受前侧和/或外侧手术和任何后侧手术的男性分别经历 36%（CI：1.09 至 1.71）和 78%（CI：1.40 至 2.26）的医疗分离风险增加。否则，女性未见这些结果的风险增加具有统计学意义。
LE-CECS 与增加的军事服务退役风险相关。在受影响的患者中，筋膜切开术并没有对职业寿命产生积极影响。然而，筋膜切开术可能只是作为最顽固病例的标志物，这些病例最不可能继续服役。需要进一步研究以阐明因果途径，并确定可能从手术治疗中获益的患者。
