有创测压装置测量骨筋膜室压力及其临床意义

Invasive compartment pressure measurement device and its clinical significance

目的 探讨使用有创测压装置诊断骨筋膜室综合征的可行性及其临床意义.方法 以血压计袖带压迫法建立新西兰大白兔骨筋膜室综合征动物模型,分别使用有创测压装置及Whiteside法测量实验动物造模前后的骨筋膜室压力.并采用统计学方法比较两种测压方法的测量结果.使用Whiteside法和有创测压装置对健康成人胫前筋膜室压力进行测量.使用有创测压装置对临床怀疑发生骨筋膜室综合征患者的筋膜室压力进行测量,指导临床上对骨筋膜室综合征的诊断与治疗.结果 使用Whiteside法测量造模前实验动物的骨筋膜室压力为（9.35±1.11）mm Hg（1 mm Hg=0.133 kPa）,使用有创测压装置测出的压力为（9.25±1.12）mm Hg,P=0.428＞ 0.05,两组数据间的差异无统计学意义,组内相关系数ICC=0.973,认为两组数据具有高度的一致性.使用Whiteside法测量造模后实验动物的骨筋膜室压力为（29.95±2.17）mm Hg,使用有创测压装置测出的压力为（30.15±2.21）mm Hg,P=0.359＞ 0.05,两组数据间的差异无统计学意义,组内相关系数ICC=0.980,同样认为两组数据具有高度的一致性.使用Whiteside法测量受测者的小腿胫前筋膜室压力为（17.28±1.78）mm Hg,使用有创测压装置测量结果为（17.45±1.73）mm Hg,P=0.273＞ 0.05,两组数据间的差异无统计学意义,组内相关系数ICC=0.986,认为两组数据具有高度的一致性.另外,使用有创测压装置测量11例怀疑发生骨筋膜室综合征患者的患肢以及健侧肢体的筋膜室压力,并监测患者血压,对比患侧及健侧肢体的骨筋膜室压力差异并计算患者△P（舒张压-筋膜室压）,指导临床诊疗.结论 使用有创测压装置与Whiteside法测量实验动物及健康成人志愿者的骨筋膜室压力结果一致,且前者可更准确地诊断骨筋膜室综合征,具有推广价值.

Objective To investigate the feasibility and clinical significance of diagnosis of osteofascial compartment syndrome using an invasive pressure measuring device.Methods Osteofascial compartment syndrome model was established in New Zealand White rabbits by sphygmomanometer cuff compression method.The pressure of the osteofascial compartment was measured by the invasive pressure measurement device and by the Whiteside method before and after estabhshment of the animal model,respectively.Values obtained by the two methods were compared and statistically analyzed.The Whiteside method and invasive pressure measurement device were then applied to detect pressure of the anterior compartment of the leg in healthy human adults.The invasive pressure measurement device was also used for detecting osteofascial compartment pressure in patients with clinical suspicion of osteofascial compartment syndrome,providing evidences for clinical diagnosis and treatment of compartment syndrome.Results The osteofascial compartment pressures detected by the Whiteside method and invasive pressure measurement device before model creation were （9.35 ± 1.11） mmHg and （9.25 ± 1.12） mmHg,respectively.There was no significant difference between the two measurements （P =0.428）.The intraclass correlation coefficient （ICC） was 0.973,suggesting a high consistency between the two sets of data.The osteofascial compartment pressures detected by the Whiteside method and invasive pressure measurement device after model establishment were （29.95 ± 2.17） mmHg and （30.15 ± 2.21） mmHg,respectively.There was no significant difference between the two measurements （P =0.359）.The ICC was 0.980,suggesting a high consistency between the two sets of data as well.The anterior compartment pressures of healthy subjects detected by the Whiteside method and invasive pressure measurement device were （17.28 ± 1.78） mmHg and （17.45± 1.73） mmHg,respectively,without any significant difference between the two measurements （P =0.273）.The ICC was 0.986,suggesting a high consistency between the two sets of data.In addition,the invasive pressure measurement device was also used for detecting the osteofascial compartment pressure in both the affected limbs and healthy limbs of 11 patients with clinically suspected compartment syndrome.Their blood pressures were also monitored for comparing the difference of osteofascial compartment pressure between the affected limbs and healthy limbs,and for calculation of △P （diastolic pressure-compartment pressure）.These data were used for guiding clinical diagnosis and treatment of osteofascial compartmentsyndrome.Conclusion Application of the invasive pressure measurement device and Whiteside method in detecting osteofascial compartment pressure achieved consistent results in experimental animals and healthy human adults.The former could diagnose osteofascial compartment syndrome more accurately,warranting its wide acceptance in clinical application.