Bermudez K, Knudson M M, Morabito D, Kessel O
Department of Surgery, University of California, San Francisco, San Francisco General Hospital, 94110, USA.
Arch Surg. 1998 Dec;133(12):1356-61. doi: 10.1001/archsurg.133.12.1356.
To test the hypothesis that fasciotomy may impair the function of the calf muscle pump, which in turn could result in the development of chronic venous insufficiency.
A cohort study of patients with a history of lower extremity fasciotomy.
An urban trauma center.
Seventeen of the 83 patients identified through trauma, vascular, and/or orthopedic registries consented to participation in this study.
Participating patients completed a study questionnaire, and then underwent a complete vascular examination, including air plethysmographic (APG) assessment. Patients with a history of venous injuries were also studied with color flow duplex venous imaging.
Function of the calf muscle pump as measured by APG, and evidence of chronic venous insufficiency as measured by APG, findings on clinical examination, and by venous ultrasonography.
Seventeen patients completed the study, including 8 with a history of vascular injuries, 6 with old fractures, and 3 who had undergone fasciotomy for soft tissue infections. The time from injury to examination ranged from 5 months to 20 years. Eight patients had signs or symptoms of venous insufficiency, the severity of which appeared to be time dependent. The APG data showed significant mean differences between fasciotomy and control extremities in ejection fraction (P<.001) and residual volume fraction (P<.001), both measures of calf muscle pump function. There were no significant changes in venous filling index, a measure of venous reflux, or in outflow fraction, which correlates with venous obstruction. There were no differences in APG variables between patients with vascular injuries vs those with orthopedic or soft tissue injuries.
Lower extremity fasciotomy impairs long-term calf muscle pump function, as measured by APG, in patients with and without vascular injuries. These patients are at risk for the long-term development of chronic venous insufficiency following lower extremity trauma.
验证筋膜切开术可能损害小腿肌肉泵功能这一假说，而这反过来可能导致慢性静脉功能不全的发生。
对有下肢筋膜切开术病史的患者进行队列研究。
城市创伤中心。
通过创伤、血管和/或骨科登记处确定的83例患者中有17例同意参与本研究。
参与研究的患者完成一份研究问卷，然后接受全面的血管检查，包括空气容积描记法（APG）评估。有静脉损伤病史的患者还接受了彩色血流双功静脉成像检查。
通过APG测量的小腿肌肉泵功能，以及通过APG、临床检查结果和静脉超声检查测量的慢性静脉功能不全的证据。
17例患者完成了研究，其中8例有血管损伤病史，6例有陈旧性骨折，3例因软组织感染接受了筋膜切开术。从受伤到检查的时间为5个月至20年。8例患者有静脉功能不全的体征或症状，其严重程度似乎与时间有关。APG数据显示，筋膜切开术肢体与对照肢体在射血分数（P<0.001）和残余容积分数（P<0.001）方面存在显著平均差异，这两项指标均为小腿肌肉泵功能的指标。静脉充盈指数（一种静脉反流指标）或与静脉阻塞相关的流出分数均无显著变化。血管损伤患者与骨科或软组织损伤患者之间的APG变量无差异。
通过APG测量，下肢筋膜切开术会损害有或无血管损伤患者的长期小腿肌肉泵功能。这些患者在下肢创伤后有发生慢性静脉功能不全的长期风险。
