CAJ | 학술논문

目的研究彩色多普勒超声(color Doppler ultrasound,CDU)在小腿急性骨筋膜室综合征(osteofascial compartment syndrome,OCS)诊断中运用的可行性及评估手术指征的价值.方法前瞻性选取36例高度怀疑或确诊小腿急性OCS的患者,针刺法测量小腿前室压力.CDU重点观察小腿肌肉纹理回声、间室横切面积、胫前胫后动脉管腔内径及多普勒频谱变化,计算小腿前室横切面积扩大率、胫前动脉管径缩小率,与临床诊断及治疗措施作相关性研究.结果 (1)21例OCS患者小腿肌肉大范围(>1/2～2/3)肿胀,回声不均匀增强,肌纹理不清或消失,室内积液、血肿;(2)小腿中段水平前室横切面积扩大率及胫前动脉中段管腔内径缩小率增高;(3)胫前动脉频谱出现双期双向舒张期全反向波、双期单向单相波、单期单向单相波及类静脉频谱波.结论 CDU可运用于小腿急性OCS的诊断,以4项指标中符合任意3项作为诊断标准的敏感性、特异性、准确性分别为86.4%、71.4%及80.6%;作为手术指征的敏感性、特异性、准确性分别为94.7%、70.6%及83.3%.
목적 연구채색다보륵초성(color Doppler ultrasound,CDU)재소퇴급성골근막실종합정(osteofascial compartment syndrome,OCS)진단중운용적가행성급평고수술지정적개치.방법 전첨성선취36례고도부의혹학진소퇴급성OCS적환자,침자법측량소퇴전실압력.CDU중점관찰소퇴기육문리회성、간실횡절면적、경전경후동맥관강내경급다보륵빈보변화,계산소퇴전실횡절면적확대솔、경전동맥관경축소솔,여림상진단급치료조시작상관성연구.결과 (1)21례OCS환자소퇴기육대범위(>1/2～2/3)종창,회성불균균증강,기문리불청혹소실,실내적액、혈종;(2)소퇴중단수평전실횡절면적확대솔급경전동맥중단관강내경축소솔증고;(3)경전동맥빈보출현쌍기쌍향서장기전반향파、쌍기단향단상파、단기단향단상파급류정맥빈보파.결론 CDU가운용우소퇴급성OCS적진단,이4항지표중부합임의3항작위진단표준적민감성、특이성、준학성분별위86.4%、71.4%급80.6%;작위수술지정적민감성、특이성、준학성분별위94.7%、70.6%급83.3%.
Objective To study the feasibility and reliability of high frequency color Doppler Ultrasound(CDU)used in the diagnosis of acute osteofascial compartment syndrome(OCS)induced by injury.Methods A total of 36 cases with extremely suspected OCS were chosen to examine the pressure of anterior leg compartment by acupuncture.The echoes of muscles,the cross section areas of anterior leg compartment,the diameter of anterior tibial artery and the flow Doppler spectra of the anterior tibial artery were emphasized.The correlationship between these data and the diagnosis as well as cure methods were studied.Results In 21 cases with OCS,leg muscles were swollen with a large extent accounting for 1/2-2/3 and with heterogeneous hyperecho in lesion unclear or disappeared muscle texture,compartment dropsy and hematoma.The dilatation rate of cross section areas in middle leg and the lessened diameter rate of the middle anterior tibial artery increased.The flow Doppler spectra of the anterior tibial artery showed 4 kinds of spectra as the following:reverse dual-phase wave of the whole diastole,positive dual-phase wave of diastole,unilateral single-phase wave and venous-like wave.Conclusions Ultrasonography is a reliable method for showing the structure of leg compartment,and could be applied to OCS.The three diagnosis indexes chosen randomly from the four indexes show that the sensitivity,specificity and accuracy are 100%,94.5% and 96.7% respectively.The sensitivity,specificity and accuracy for operation are 94.7%,70.6% and 83.3%.