Jorge Pedro Baches, Toledo Mariana Belaunde, Mari Flora Chaves, Toledo Rodrigo Ruas Floriano de, Lima Marcos Vaz de, Sprey Jan Willem Cerf
Grupo de Trauma do Esporte, Departamento de Ortopedia e Traumatologia, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brasil.
Grupo de Medicina do Esporte, Departamento de Ortopedia e Traumatologia, Irmandade de Misericórdia da Santa Casa de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ortop (Sao Paulo). 2024 Jul 15;59(5):e650-e656. doi: 10.1055/s-0044-1787766. eCollection 2024 Oct.
Chronic compartment syndrome (CCS) is a pressure increase within a non-expandable fibro-osseous space resulting from continuous and intense physical activity. Its symptoms usually improve with rest or reduced activity. It is a critical cause of lower limb pain in athletes and the second most common cause of effort-related leg pain. Less frequent reports include CCS in the lumbar paravertebral compartments, in the hand, the forearm, the thigh, and the foot. Although CCS mainly affects long-distance runners, it may also occur in sports such as lacrosse, football, basketball, skiing, and field hockey. Muscle tension, cramps, symptoms worsening with physical exercise, pain, and reduced sensitivity in the upper part of the foot are the main CCS findings, and diagnosis is essentially clinical. Even though controversial and with some limitations, CCS diagnosis has relied on measuring the intracompartmental pressure after exercise. However, new alternative tools are under study, particularly those less invasive, such as magnetic resonance imaging (MRI) after the exercise protocol. For years, open fasciotomy was the most relevant treatment for CCS in athletes, but new surgical techniques are gaining importance, such as minimally-invasive fasciotomy and endoscopic procedures. Some conservative therapies hold promise as potential alternatives for patients who do not want surgery, but robust evidence to support them remains lacking, especially for athletes.
慢性骨筋膜室综合征（CCS）是由于持续剧烈的体力活动导致不可扩张的纤维骨性间隙内压力升高。其症状通常在休息或减少活动后改善。它是运动员下肢疼痛的关键原因，也是与运动相关的腿痛的第二大常见原因。较少见的报道包括腰椎旁间隙、手部、前臂、大腿和足部的CCS。虽然CCS主要影响长跑运动员，但也可能发生在长曲棍球、足球、篮球、滑雪和曲棍球等运动中。肌肉紧张、痉挛、运动时症状加重、疼痛以及足部上部感觉减退是CCS的主要表现，诊断主要依靠临床症状。尽管存在争议且有一定局限性，但CCS的诊断一直依赖于运动后测量骨筋膜室内压力。然而，新的替代工具正在研究中，特别是那些侵入性较小的工具，如运动方案后的磁共振成像（MRI）。多年来，开放性筋膜切开术一直是运动员CCS最主要的治疗方法，但新的手术技术，如微创筋膜切开术和内镜手术，正变得越来越重要。对于不想手术的患者，一些保守治疗有望成为潜在的替代方法，但仍缺乏有力证据支持，尤其是对运动员而言。
