小腿骨筋膜间隔综合征分级

Classification of lower leg osteofacial compartment syndrome

骨筋膜间隔综合征(OCS)是创伤骨科严重并发症之一。若不及时处理,会造成神经和肌肉不可逆损伤,严重者可导致截肢甚至死亡。"5P"是临床上较经典的OCS诊断方法,但存在较大主观性,且不能及时准确反映病情进展。筋膜间隔测压法是诊断OCS主要的辅助手段,虽然测压方法较多,但目前仍无权威的压力阈值作为诊断标准。为避免发生严重并发症,临床医师常积极行筋膜切开术,导致不必要的筋膜切开。笔者回顾2010年3月至2020年3月解放军东部战区空军医院收治的小腿OCS患者的临床资料,发现部分患者通过解除支具、稳定肢体和消肿等非手术治疗,临床表现逐渐缓解,无须行筋膜切开术;部分患者通过上述非手术治疗,症状进行性加重,需要及时行筋膜切开术。笔者依据临床体检定性结果和双侧动脉平均血流速度比、脉搏波改变等定量指标对OCS严重程度进行分级,首次提出OCS分级判断标准,旨在针对不同OCS分级的患者采取相应的干预措施,进行更精准的治疗,为OCS诊治提供参考。

Osteofacial compartment syndrome(OCS)is one of the serious complications in traumatic orthopedics.If not treated in time,OCS may result in irreversible damage to nerve and muscle,even amputation or death in serious condition.5P presents to be the classic clinical diagnosis of OCS,but it is highly subjective and cannot timely and accurately judge the progression of the disease.Intracompartment pressure manometry is the main auxiliary method for the diagnosis of OCS.Although there are many manometry methods,there is still no authoritative pressure threshold as the diagnosis standard.Clinicians often aggressively perform fasciotomy to avoid serious complications,leading to unnecessary fasciotomy.The authors retrospectively reviewed the data of patients with OCS treated at Air Force Hospital of Eastern Theater of PLA from March 2010 to March 2020 and found that some patients with OCS had gradual alleviation of clinical symptoms after appropriate conservative treatments such as brace releasing,limb stabilization and swelling subsidence,with no need of fasciotomy.However,the symptoms of some patients progressively aggravated after the above-mentioned traditional treatments and timely fasciotomy was required.The authors graded the severity of OCS and proposed for the first time the OCS grading criteria according to quantitative clinical results and quantitative indicators such as ratio of mean blood flow velocity of bilateral arteries and pulse wave changes,aiming to take corresponding intervention measures for patients with different OCS classifications,carry out more precise treatment and avoid unnecessary fasciotomy.