应用MRI研究创伤后骨筋膜室压力与骨骼肌纤维化修复的关系

目的应用MRI研究创伤后骨筋膜室压力与骨骼肌纤维化修复以及远期患肢功能的关系。方法选取36例具有完整骨筋膜室压力数据并行骨折切开复位内固定术的患者,在内固定物取出术后2个月进行MRI检查,评估骨骼肌纤维化修复的情况。末次随访时,分别采用DASH评价系统及IOWA评分系统评估患肢功能的恢复情况,并进行统计学分析。结果患者均获得骨性愈合,并顺利完成内固定物取出术及MRI检查,经过软件测量及统计学分析,患侧/健侧肌肉体积比和患侧/健侧肌肉T2WI信号比与骨筋膜室压力的最高值、ΔP(舒张压减去患肢的骨筋膜室压力)的最低值、骨筋膜室压力的累积值以及ΔP的累积值均相关,且与ΔP的累积值相关度最高。患肢功能评分为75~98分,与患侧/健侧肌肉体积比和T2WI信号比的Pearson积距相关系数分别为0.735和-0.799。结论骨骼肌的纤维化修复与骨筋膜室压力,尤其是ΔP的累积值密切相关。

Application of MRI in the study of intracompartmental pressure and skeletal muscle fibrosis after trauma

Objective To study the relationship between intracompartmental pressure(ICP)and skeletal muscle fibrosis,the long-term function of the affected limb by using MRI.Methods A total of 36 cases with complete data of ICP were selected and treated with open reduction and internal fixation of fracture.At 2 months after removal of the internal fixation,MRI was performed to evaluate the repair situation of skeletal muscle fibrosis.Clinical evaluation of the limb function at last follow-up was performed by DASH and IOWA score system.And all data were performed statistical analysis.Results All cases obtained bony union,and were successfully completed internal fixation removal,and MRI examination was performed.After the software measurement and statistical analysis,suffered/uninjured muscle volume ratio and suffered/uninjured muscle T2WI signal ratio were related to the maximum value of ICP,the minimum value ofΔP(diastolic blood pressure subtracted ICP of affected limb),the cumulative value of ICP andΔP,and had the highest correlation with the cumulative value ofΔP.The limb function score of affected limbs was 75~98 points.The correlation coefficients between the ratio of muscle volume and T2WI signal and the function of limb were 0.735 and-0.799.Conclusions The skeletal muscle fibrosis is related to ICP,especially closely related to the cumulative value ofΔP.