asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-009asurgery-351Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYХронический компартмент-синдром нижних конечностей: современные стратегии диагностики и леченияChronic compartment-syndrome of the lower limb: modern strategies for diagnosis and treatmenthttps://orcid.org/0000-0001-7473-6692КаторкинС. Е.KatorkinS. E.

Каторкин Сергей Евгеньевич, д.м.н., профессор, заведующий кафедрой и клиникой госпитальной хирургии,

443089, Самара, ул. Чапаевская, д. 89

Sergey E. Katorkin, Dr. Sci. (Med.), Professor, Head of the Department and Clinic of Hospital Surgery,

89, Chapaevskaya St., Samara, 443089

katorkinse@mail.ruhttps://orcid.org/0000-0001-8764-2054КушнарчукМ. Ю.KushnarchukM. Y.

Кушнарчук Михаил Юрьевич, врач сердечно-сосудистый хирург отделения сосудистой хирургии клиники госпитальной хирургии, ассистент кафедры госпитальной хирургии, 

443089, Самара, ул. Чапаевская, д. 89

Mikhail Y. Kushnarchuk, Cardiovascular Surgeon, Department of Vascular Surgery Hospital Surgery Clinic, Assistant of the Department of Hospital surgery, 

89, Chapaevskaya St., Samara, 443089

m.kushnarchuk@outlook.comСамарский государственный медицинский университетРоссияSamara State Medical UniversityRussian Federation2023190520232016980Copyright © Каторкин С.Е., Кушнарчук М.Ю., 20232023Каторкин С.Е., Кушнарчук М.Ю.Katorkin S.E., Kushnarchuk M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/351

Представлен обзор литературы, включающий данные о заболеваемости, патофизиологии, клинической картине пациентов с хроническим компартмент-синдромом (CCS) нижних конечностей. Хронический компартмент-синдром физического напряжения (CECS) характеризуется болью при повторяющейся физической нагрузке и повышенным внутрикомпартментным давлением, поражающим нижние конечности у физически активных пациентов. При выраженной хронической венозной недостаточности нижних конечностей развивается хронический венозный компартмент-синдром (CVCS), принципиально отличающийся от ранее известных клинических картин. Прогрессирующий дерматолипофасциосклероз и рубцовая деструкция фасции голени у пациентов С4b-C6 клинических классов по CEAP оказывают влияние на давление в мышечно-фасциальных компартментах при каждом шаге. В тяжелых случаях это приводит к значительным изменениям в мышцах, сопровождающимся хронической ишемией, связанной с некрозом и дефицитом гликогена. Проведен анализ различных методов диагностики, консервативного лечения и способов выполнения хирургической декомпрессии CCS. Отсутствие четкой патофизиологии CECS и CVCS усложняет диагностику и лечение этого состояния. Диагноз CCS голени по-прежнему основывается на тестировании давления в мышечно-фасциальных компартментах голени с использованием критериев Pedowitz, однако стандартные процедуры для этого, включая положение пациента, статические или динамические движения, тестируемые мышцы и оборудование, не согласованы. У пациентов с CCS при неэффективности консервативного лечения методом выбора является фасциотомия пораженных отделов голени. Различные методы фасциотомии голени включают традиционную открытую фасциотомию, полузакрытую технику с одним или несколькими разрезами, минимально инвазивную технику с использованием эндоскопического высвобождения компартмента и использование УЗ-контроля. Фасциэктомия голени с целью коррекции CVCS выполняется преимущественно при рецидивах трофических язв после shave therapy, выраженной кальцификации тканей голени и для лечения глубокого трансфасциального некроза. Для дальнейшего расширения знаний о диагностике и лечении CCS необходимы рандомизированные, слепые, контролируемые исследования. 

A review of the literature is presented, including data on the incidence, pathophysiology, and clinical picture of patients with chronic compartment syndrome (CCS) of the lower extremities. Chronic exercise compartment syndrome (CECS) is characterized by pain with repetitive exertion and increased intracompartmental pressure affecting the lower extremities in physically active patients. In severe chronic venous insufficiency of the lower extremities, chronic venous compartment syndrome (CVCS) develops, which is fundamentally different from previously known clinical pictures. Progressive dermatolipofasciosclerosis and cicatricial destruction of the fascia of the leg in patients with C4b-C6 clinical classes according to CEAP affect the pressure in the muscle-fascial compartments at each step. In severe cases, this leads to significant changes in the muscles, accompanied by chronic ischemia associated with necrosis and glycogen deficiency. The analysis of various diagnostic methods, conservative treatment and methods for performing surgical decompression of the CCS was carried out. The lack of a clear pathophysiology for CECS and CVCS complicates the diagnosis and treatment of this condition. Diagnosis of calf CCS is still based on pressure testing in the musculofascial compartments of the calf using the Pedowitz criteria, however standard procedures for this, including patient position, static or dynamic movements, muscles and equipment tested, are not agreed upon. In patients with CCS, if conservative treatment is ineffective, fasciotomy of the affected parts of the lower leg is the method of choice. Various techniques for fasciotomy of the lower leg include the traditional open fasciotomy, the semi-closed technique with one or more incisions, the minimally invasive technique using endoscopic compartment release, and the use of ultrasound guidance. Fasciectomy of the lower leg to correct CVCS is performed mainly for recurrence of trophic ulcers after shave therapy, severe calcification of the lower leg tissues and for the treatment of deep transfascial necrosis. Randomized, blinded, controlled trials are needed to further expand our knowledge of the diagnosis and treatment of CCS. 

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The authors declare that there are no conflicts of interest present.