Muller G P, Masquelet A C
Service d'Orthopédie-Traumatologie, CHU Avicenne, Bobigny.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(6):549-52.
The aim of this paper is to present an unusual localization of a chronic compartment syndrome concerning the medial compartment of the foot. It emphasizes surgical treatment, using a fasciotomy procedure.
A thirty year old man was examined for a painful right foot. Pain was situated on the medial plantar aspect of the foot. It appeared following 15 minutes of physical effort, especially after walking and running. It usually disappeared after a few minutes of rest and then, foot and lower leg examination were normal. The patient had comparative tissue pressure measurements at rest and after running, using a digital hand-held monitor (Stryker). A rest, the pressure was about 4 mmhg on both sides and it increased to 55 mmhg against 45 mmhg at the opposite side after exercise. It required more than 7 minutes vs. 30 seconds to return to their preexercise resting values. Thus a fasciotomy of the medial compartment was performed, using a medial approach.
The patient had a good result at three months follow-up, recovering normal physical activity without any pain.
The foot localization of an acute compartment syndrome has been recently described and it concerned only post-traumatic cases. The compartmental structure of the foot has been previously report. The chronic compartment syndrome of the lower leg was the reason for a pressure measurement study, at rest and following physical exercise; thus surgical fasciotomy was indicate when intracompartmental pressure rose above 30 mmHg in the presence of normal diastolic blood pressure, and particularly if delayed normalization of the pressure was greater than 5 minutes. The publications of foot pressure measurement are uncommon and they concerned only pressure at rest. In our observation, the profile of pressure of the patient and the result of fasciotomy, are in favour of chronic compartment syndrome.
Chronic compartment syndromes require dynamic pressure measurements for an accurate diagnosis. Surgical fasciotomy may be sufficient to restore muscle function. We think this syndrome could happen in all anatomical compartmental structure when there is intensive use of muscles.
本文旨在介绍足部内侧间隔慢性骨筋膜室综合征的一种罕见定位情况。强调采用筋膜切开术进行手术治疗。
对一名30岁男性的右足疼痛情况进行检查。疼痛位于足底内侧。在进行15分钟体力活动后出现，尤其是行走和跑步后。通常在休息几分钟后消失，此时足部和小腿检查正常。使用数字手持式监测仪（史赛克）对患者在休息时和跑步后进行组织压力比较测量。休息时，两侧压力约为4 mmHg，运动后一侧升至55 mmHg，而另一侧为45 mmHg。恢复到运动前的休息值，患侧需要7分钟以上，而对侧只需30秒。因此，采用内侧入路对内侧间隔进行了筋膜切开术。
患者在三个月随访时效果良好，恢复了正常体力活动且无任何疼痛。
急性骨筋膜室综合征的足部定位情况最近已有描述，但仅涉及创伤后病例。足部的间隔结构此前已有报道。小腿慢性骨筋膜室综合征是进行休息时和体育锻炼后压力测量研究的原因；因此，当舒张压正常时，若间隔内压力升至30 mmHg以上，特别是压力恢复正常的延迟时间大于5分钟时，应进行手术筋膜切开术。足部压力测量的相关文献并不常见，且仅涉及休息时的压力。在我们的观察中，患者的压力情况及筋膜切开术的结果支持慢性骨筋膜室综合征的诊断。
慢性骨筋膜室综合征需要进行动态压力测量以准确诊断。手术筋膜切开术可能足以恢复肌肉功能。我们认为，当肌肉过度使用时，这种综合征可能发生在所有解剖间隔结构中。
