Balduini F C, Shenton D W, O'Connor K H, Heppenstall R B
Department of Orthopaedics, University of Pennsylvania, Philadelphia.
Clin Sports Med. 1993 Jan;12(1):151-65.
In the past 5 years, a great deal of time and effort has been expended in an effort to better define clinical, anatomic, and laboratory parameters of CECS. It is now a well-recognized entity and one that can be readily resolved with fasciotomy. But the reasons for predisposition and the pathophysiologic mechanisms remain obscure. It appears, however, that basing the decisions for fasciotomy on clinical characteristics alone leads to overdiagnosis and excessive surgery. In this series, almost 50% of the referred subjects failed to demonstrate adequate laboratory criterion for the diagnosis of CECS. Fasciotomy in these patients may have effected a cure, but the reasons may be unrelated to increased intracompartmental pressure. Furthermore, in the laboratory diagnosis of CECS, the rate of return to resting compartment pressure following exercise seems more accurate than reliance on resting pressure alone. 31P-NMR has proved valuable in the dynamic assessment of muscle ischemia as reflected by relative PCr concentrations. Finally, although a mechanism explaining the source of pain has not been established by this study, it appears that ischemia is not a significant factor.
在过去5年里，人们花费了大量时间和精力来更好地界定慢性运动性筋膜间隔综合征（CECS）的临床、解剖学和实验室参数。现在它已成为一个广为人知的病症，且通过筋膜切开术能够轻易解决。但其易患因素和病理生理机制仍不清楚。然而，似乎仅依据临床特征来决定是否进行筋膜切开术会导致过度诊断和过度手术。在本系列研究中，几乎50%的转诊患者未显示出诊断CECS的充分实验室标准。对这些患者进行筋膜切开术可能治愈了疾病，但原因可能与筋膜间隔内压力升高无关。此外，在CECS的实验室诊断中，运动后恢复到静息筋膜间隔压力的速率似乎比仅依赖静息压力更准确。31P - 核磁共振已被证明在通过相对磷酸肌酸浓度反映的肌肉缺血动态评估中具有价值。最后，尽管本研究尚未确立解释疼痛来源的机制，但似乎缺血不是一个重要因素。
