Name: a novel non-invasive method for the detection of elevated intra-compartmental pressures of the leg
Uploaded: 2019-05-31T15:00:00
Description: Watch this Scientific Journal Video about A Novel Non-invasive Method for the Detection of Elevated Intra-compartmental Pressures of the Leg at JoVE.com

本实验方案已得到我院机构审查委员会 (IRB) 的审查和批准, 并遵循本机构人类研究伦理委员会制定的所有指导方针。
1. 识别腿前室的节段
<ol><li>确定超声波探头的起始位置。将探头直接放在前隔间上, 仅侧侧到胫骨顶部, 一个手宽远端到胫骨结节。</li>
	<li>识别筋膜为在超声上皮下组织下方的明亮的白色条。移动探针, 直到在它附着到胫骨冠的地方看到筋膜。</li>
	<li>请注意?...

<ol>
	<li>Ulmer, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+clinical+diagnosis+of+compartment+syndrome+of+the+lower+leg:+are+clinical+findings+predictive+of+the+disorder?.">The clinical diagnosis of compartment syndrome of the lower leg: are clinical findings predictive of the disorder?.</a> Journal of Orthopaedic Trauma. 16 (8), 572-577 (2002).</li><li>Whitesides, T. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tissue+pressure+measurements+as+a+determinant+for+the+need+of+fasciotomy.">Tissue pressure measurements as a determinant for the need of fasciotomy.</a> Clinical Orthopaedics and Related Research. 113, 43-51 (1975).</li><li>McQueen, M. M., Court-Brown, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Compartment+monitoring+in+tibial+fractures:+the+pressure+threshold+for+decompression.">Compartment monitoring in tibial fractures: the pressure threshold for decompression.</a> The Journal of Bone and Joint Surgery. British Volume. 78 (1), 99-104 (1996).</li><li>McQueen, M. M., Christie, J., Court-Brown, C. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Compartment+pressures+after+intramedullary+nailing+of+the+tibia.">Compartment pressures after intramedullary nailing of the tibia.</a> The Journal of Bone and Joint Surgery. British Volume. 72 (3), 395-397 (1990).</li><li>Masquelet, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acute+compartment+syndrome+of+the+leg:+pressure+measurement+and+fasciotomy.">Acute compartment syndrome of the leg: pressure measurement and fasciotomy.</a> Orthopaedics &amp; Traumatology: Surgery &amp; Research. 96 (8), 913-917 (2010).</li><li>McQueen, M. M., Duckworth, A. D., Aitken, S. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+estimated+sensitivity+and+specificity+of+compartment+pressure+monitoring+for+acute+compartment+syndrome.">The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome.</a> Journal of Bone and Joint Surgery. 95 (8), 673-677 (2013).</li><li>Whitney, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Do+one-time+intracompartmental+pressure+measurements+have+a+high+false-positive+rate+in+diagnosing+compartment+syndrome?.">Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?.</a> Journal of Trauma and Acute Care Surgery. 76 (2), 479-483 (2014).</li><li>Sellei, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+elevated+compartment+pressures+by+pressure-related+ultrasound:+a+cadaveric+model.">Assessment of elevated compartment pressures by pressure-related ultrasound: a cadaveric model.</a> European Journal of Trauma and Emergency Surgery. 41 (6), 639-645 (2015).</li><li>Sellei, R. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Compartment+elasticity+measured+by+pressure-related+ultrasound+to+determine+patients+&#8220;at+risk&#8221;+for+compartment+syndrome:+an+experimental+in+vitro+study.">Compartment elasticity measured by pressure-related ultrasound to determine patients &#8220;at risk&#8221; for compartment syndrome: an experimental in vitro study.</a> Patient Safety in Surgery. 9 (1), 4 (2015).</li><li>Bloch, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Compression+sonography+for+non-invasive+measurement+of+lower+leg+compartment+pressure+in+an+animal+model.&amp;#34;.">Compression sonography for non-invasive measurement of lower leg compartment pressure in an animal model.&amp;#34;.</a> Injury. 49 (3), 532-537 (2018).</li><li>Marmor, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+standard+musculoskeletal+ultrasound+to+determine+the+need+for+fasciotomy+in+an+elevated+muscle+compartment+pressure+cadaver+leg+model.">Use of standard musculoskeletal ultrasound to determine the need for fasciotomy in an elevated muscle compartment pressure cadaver leg model.</a> Injury. , (2019).</li></ol>

本文展示了一种新的临床应用技术, 用于使用超声与压力传感器耦合, 无创测量腿部的组织内压力。这种技术只需要手持超声和市售的压力传感传感器。它是快速和容易的执行, 并有良好的耐受性的病人。整个诊断过程可以在5分钟内完成, 无需额外资源。然后, 计算出的三角洲 CFFP 可与身体检查一起使用, 以评估受伤腿的减压筋膜切开术的需要。
该协议的关键步骤是在筋膜层完?...

这一新方案的目的是使用超声传感器和压力传感器, 以非侵入性的方式评估腿部的组织内压力。隔间综合征是肌肉骨骼损伤中众所周知的并发症, 是由于组织内压力升高, 如果不干预, 会损害组织的灌注, 从而导致不可逆转的缺血性损伤。其诊断主要是基于临床检查。不幸的是, 仅临床检查已被证明在诊断隔间综合征1的敏感性和特异性差。采用针压测量法测量室内压力是常见的方法, 用于评估2、3、4 室综合征。针式测数的缺点是, 它是一个侵入性的程序, 是相当不舒服的病人, 不适合连续测量。此外, 由于在诊断 ACS 和高 (35%) 的适当阈值压力上存在相当大的分歧, 一些外科医生没有例行进行侵入性的术室内压力测量测量。一次侵入性测量 5, 6,7的假阳性率和变异性。
此前已在人工、动物和人体尸体模型中证明, 组织内压力的升高会导致前隔间上的筋膜弹性下降, 这表明通过超声测量的术中部内压力和面部隔间的依从性 8,9, 10。进一步的工作描述了使用所需的压力, 以平展前室的筋膜, 通过超声波测量 (隔间法法扁平压力 [CFFP]) 作为替代措施的术, 术后的部门内压力11。前室筋膜可以很容易地可视化与标准的超声检查, 并与压力传感器添加到探头, Cffp 可以很容易和可靠地测量。该方案提供了一种非侵入性的诊断替代方案, 用于评估术内压力, 并且可以快速连续地进行, 几乎没有患者不适。

<table>
<tbody>
<tr>
<td>Pressure sensor: Venous pressure measurement device</td>
<td>Vein press</td>
<td>VP 2014</td>
<td>A peripheral venous measuring device used in conjuction with an ultrasound to measure peripheral venous pressure.</td>
</tr>
<tr>
<td>Ultrasound probe: Vscan Extend R2 Dual Probe DICOM Base Package</td>
<td>GE Healthcare</td>
<td>H8038VP</td>
<td>Any ultrasound probe will be sufficent for this test. Using the narrow tranducer will function best when coupled to the pressure sensor</td>
</tr>
</tbody>
</table>

a novel non-invasive method for the detection of elevated intra-compartmental pressures of the leg

急性室间综合征是肌肉骨骼损伤的毁灭性后果。目前的诊断是基于临床体征和症状, 虽然辅助药物, 如侵入性的术中压力测量经常被用来证实体检结果, 但仍然没有可靠的客观测试来帮助决定进行减压筋膜切开术。在隔间综合征的尸体模型中, 基于超声波 (US) 的方法已被证明是一种可靠的测量增加的室内压力。Gt;100 mbar 的绝对压力或两腿之间 CFFP 的差异可被认为是病理因素。使用超声波换能器, 再加上压力传感器, 可以测量扁平下肢前室表面筋膜所需的压力 (隔间筋膜扁平压力 [CFFP])。将受伤腿的 CFFFP 与未受伤腿的 CFFFP 进行比较。这个美国测量的指数可以作为身体检查的辅助评估受伤的下肢和评估需要减压筋膜切开术。该协议的优点包括: 非侵入性方法和易于重现的技术。

这项技术已被用来测量10例连续受伤的腿部患者, 没有证据的隔间综合征和3例患者的临床诊断室综合征需要解压筋膜切开术。无隔间综合征患者的平均三角洲 cffffp 为10.7±10.6 毫巴, 而隔间综合征患者的平均增量 CFFFP 为157±51.7 毫巴, 单尾 t-试验发现两组间压力的差异是统计上的(P < 0.02)。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/59887/59887fig01v2.jpg"> <...

Watch this Scientific Journal Video about A Novel Non-invasive Method for the Detection of Elevated Intra-compartmental Pressures of the Leg at JoVE.com

A Novel Non-invasive Method for the Detection of Elevated Intra-compartmental Pressures of the Leg

超声波探头与压力传感器相结合, 通过直接测量隔间筋膜扁平压力 (CFFP) 来评估腿部的门内压力。这种非侵入性的治疗方案将提供可靠的评估压力内的前肌肉室的小腿。

一种检测腿部高室内压力的无创检测方法

Acute Compartment Syndrome is a devastating consequence of musculoskeletal trauma. Currently the diagnosis is based on clinical signs and symptoms, and ...

该协议具有独特的意义，因为它是评估腿部的节内压力的非侵入性方法。这在评估受伤的四肢时可能很重要，这有感染隔间综合征的风险，这是一种威胁肢体的情况。随着舱内压力的上升，舱内结构的灌注减少，导致缺血性侮辱。如果不快速识别和处理升高的压力，车厢将死亡，从而造成永久性残疾。这种技术的主要优点是非侵入性。目前，测量舱内压力的唯一方法就是将装有压力表的大孔针插入腿部舱内。虽然可靠，但这项技术对患者来说相当不舒服，不适合进行串行测量。对于第一次尝试这种技术的人，我建议他们先在志愿者上练习这项技术。首先，学习应用和解释超声波图像的压力可能很困难。要开始此过程，请确定超声波探针的起始位置。将探针直接放在前隔间上，只是侧向三角峰，一只手的宽度向三角体。接下来，确定筋膜，这是超声波下皮组织正下方的亮白色条。移动探头，直到在附着在三足顶的点看到筋膜。请注意筋膜的几何形状。应用最小时，这应该是凸形。一旦确定前室的筋膜，对超声波探头施加缓慢而稳定的压力，直到筋膜从凸体变形为完全平坦。尝试几次，包括通过平展点生成凹形，以努力在精确的隔间筋膜压上轻轻磨练。一旦前室筋膜完全平坦，记录压力传感器测量。重复 CFFP 测量两次。记录一个平均值，所有三个压力，以定义受伤的腿的最终CFFP。首先，以与前面描述的相同方式测量和记录反向腿部中的 CFFP。通过从井腿的 CFFP 中考虑受伤腿部的 CFFP 之间的差值来计算增量 CFFP。在这项研究中，一种新型的、临床上适用的技术，用于使用超声波与压力传感器相结合，对腿部的节内压力进行非侵入性测量。该技术已用于测量连续10名腿部受伤患者，无隔间综合征证据，3名患者的隔间综合征临床诊断，需要减压筋膜切除术。无隔间综合征患者的平均增量 CFFP 约为 10.7 毫巴，而隔间综合征患者的平均增量 CFFP 约为 157 毫巴。单尾 T 检验确定各组之间的压力差异具有统计显著性。执行此技术时，当筋膜从凸体变化为完全平坦时，确定确切点的压力非常重要。为了最好地促进这种情况，当执行技术的人保持对超声波的关注时，让助手可以读取压力是有帮助的。一旦筋膜从凸体变化为平面，执行测试的人可以发出压力，发出信号助手记录压力读数。执行此诊断测试后，结果可与评估室内压力（即针测仪）的黄金标准进行比较。最常用的设备是 Stryker 快速压力监视器组。

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