腰骶部慢性骨筋膜间隔综合征解剖及临床研究现状

Anatomical and clinical research about chronic compartment syndrome of waist

目的:总结近年来腰骶部慢性骨筋膜间隔综合征的研究现状,以期提高人们对腰骶部骨筋膜间隔综合征的认识、诊断及治疗。方法:应用计算机检索CNKI1994-01/2007-03及万方数据库2000-01/2007-03相关腰骶部慢性骨筋膜间隔综合征方面的文献,检索词"下腰痛,腰肌劳损,腰骶部骨筋膜间隔综合征",限定文章语言种类为中文。同时计算机检索PubMed、Medline、Springerlink2000-01/2007-03及Embase数据库2003-01/2007-03相关腰骶部慢性骨筋膜间隔综合征方面的文献,检索词"LBP,lumbar muscle strain,Chronic Compartment syndrome",并限定文章语言种类为English。对资料进行初审,选取包括腰骶部慢性骨筋膜间隔综合征的文献,开始查找全文,并查看每篇文献后的引文。纳入标准:文章所述内容应与慢性骨筋膜室综合征、慢性下腰痛、肌内压测定有关。排除标准:重复研究或Meta分析类文章。结果:共检索到45篇关于腰骶部慢性骨筋膜间隔综合征的文献,最终纳入15篇符合标准的文献。腰骶部骨筋膜间隔综合征目前尚未被普遍认识,但是1981年Peck就首次报道腰部骨筋膜间隔综合征,并提出该病可能是下腰痛原因之一。腰骶部骨筋膜间隔综合征与其他部位的骨筋膜间隔综合征病理变化相似,若得不到及时治疗就会引起肌肉的变性、坏死及纤维化,这是腰肌劳损形成的重要病理原因之一。诊断腰骶部慢性骨筋膜间隔综合征需要在排除其他疾病的基础上结合骨筋膜间隔内压力测定。骨筋膜间隔内压力的直接测定仍然是骨筋膜间隔综合征诊断的金标准。目前骨筋膜间隔综合征治疗四肢部位都趋向于行解压手术治疗,腰骶部的骨筋膜间隔综合征治疗意见不一,保守治疗虽然可以暂时缓解酸痛症状但疗效没有确切的统计学依据,并且不能预防阻止受压的骨骼肌变性。筋膜切开解压术是针对此病的基本疗法,有关专家的研究表明术前术后效果明显。因此对腰骶部骨筋膜间隔综合征的认识、诊断及治疗,对预防或减少慢性腰肌劳损所致的慢性腰痛具有重要意义。结论:腰骶部慢性骨筋膜间隔综合征可引起下腰痛,保守治疗虽然可以暂时起效但不能根本解决问题,手术治疗仍是基本的治疗手段。

AIM： To summarize the research status of chronic compartment syndrome of waist, so as to enhance the understanding, diagnosis and treatment of chronic compartment syndrome of waist. METHODS： A computer-based online search of CNKI from January 1994 to March 2007 and Wanfang from January 2000 to March 2007 was undertaken for the Chinese articles about chronic compartment syndrome of waist with the keywords of ＂lower back pain, lumbar muscle strain, chronic compartment syndrome of waist＂ in Chinese. Meanwhile, we searched Pubmed, Medline, Springlink and Embase for related articles published in English between January 2003 and March 2007 with the keywords of ＂LBP, lumbar muscle strain, Chronic compartment syndrome＂. Articles about chronic compartment syndrome of waist were selected after the primary trial, and the full-text was looked over. References of each article were looked up. Articles about chronic low back pain （LBP）, chronic compartment syndrome （CCS） of waist and measurement of intramuscular pressure were selected. Repetitive researches or Meta analysis were excluded. RESULTS： Forty-five articles about the CCS were collected, and finally 15 met the requirements. Chronic compartment syndrome of waist is not widely acknowledged now. But it was firstly reported by Peck in 1981, who pointed that it might be one of the probable causes of LBP. The pathological change between the chronic compartment syndrome of waist and the CCS on other parts is similar. If not treated timely, the relevant muscle will get denaturalized or be of putrescence and fibrosis. And this is one of the most important pathology causes of the formation of lumbar muscle strain. The diagnosis of CCS should be based on the exclusion of other disease and with the inner pressure measurement of the compartment, which is still the golden standard for the diagnosis of CCS. Now the treatment of the limb parts of the CCS tends to surgical way, but the treatments about the CCS are not unanimously accepted. Conservative treatment may reduce the pain temporarily, but its effect is lacking of tangible statistical bases. Either it cannot prevent the denaturalization of the pressured skeletal muscle. Fasciotomy is the basic therapy for this syndrome with distinct effect proved by the relevant experts. Therefore, the understanding, diagnoses and treatment of CCS is significant to the prevention or reduction of the LBP caused by chronic lumbar muscle strain. CONCLUSION： CCS may cause LBP. Conservative therapy may work temporarily, but it cannot solve the problem totally. Surgery still remains the basic treatment.