Abstract：
OBJECTIVE: Lower extremity chronic exertional compartment syndrome (LE-CECS) can limit rigorous physical activity, particularly in the US military, and fasciotomy is a potential treatment. Associations between LE-CECS, fasciotomy, and occupational outcomes appear understudied. We studied active-duty US service members to identify whether LE-CECS diagnoses and fasciotomy for LE-CECS predict military service separation.
METHODS: We conducted a retrospective cohort study of 1,103,417 individuals who entered service during 2011 to 2017. Distributions of separation statuses and independent variables were tabulated, and sex-specific multivariable regression models were computed for separation outcomes.
RESULTS: LE-CECS was associated with a 474% medical service separation risk in men (95% confidence interval (CI) for adjusted risk ratio: 5.21 to 6.33) and a 282% increase in women (CI: 2.99 to 4.88). Among 1947 patients with LE-CECS, men saw a 57% nonmedical separation risk increase (CI: 1.27 to 1.93) and women had a 119% increase (CI: 1.10 to 4.35) when anterior and/or lateral compartment procedures occurred. Men with LE-CECS and any posterior procedures saw a 47% nonmedical separation risk increase (CI: 1.17 to 1.86). Men with anterior and/or lateral procedures and any posterior procedures experienced 36% (CI: 1.09 to 1.71) and 78% (CI: 1.40 to 2.26) medical separation risk increases, respectively. No statistically significant risk increases for the outcomes were otherwise seen for women.
CONCLUSIONS: LE-CECS was associated with increased military service discharge risks. Among the affected patients, positive effects on career longevity were not seen in association with fasciotomy. However, fasciotomy could simply serve as a marker of the most refractory cases that are least likely to continue service. More study is needed to clarify causal pathways and identify patients who may derive career benefits from surgical treatment.
METHODS: We conducted a retrospective cohort study of 1,103,417 individuals who entered service during 2011 to 2017. Distributions of separation statuses and independent variables were tabulated, and sex-specific multivariable regression models were computed for separation outcomes.
RESULTS: LE-CECS was associated with a 474% medical service separation risk in men (95% confidence interval (CI) for adjusted risk ratio: 5.21 to 6.33) and a 282% increase in women (CI: 2.99 to 4.88). Among 1947 patients with LE-CECS, men saw a 57% nonmedical separation risk increase (CI: 1.27 to 1.93) and women had a 119% increase (CI: 1.10 to 4.35) when anterior and/or lateral compartment procedures occurred. Men with LE-CECS and any posterior procedures saw a 47% nonmedical separation risk increase (CI: 1.17 to 1.86). Men with anterior and/or lateral procedures and any posterior procedures experienced 36% (CI: 1.09 to 1.71) and 78% (CI: 1.40 to 2.26) medical separation risk increases, respectively. No statistically significant risk increases for the outcomes were otherwise seen for women.
CONCLUSIONS: LE-CECS was associated with increased military service discharge risks. Among the affected patients, positive effects on career longevity were not seen in association with fasciotomy. However, fasciotomy could simply serve as a marker of the most refractory cases that are least likely to continue service. More study is needed to clarify causal pathways and identify patients who may derive career benefits from surgical treatment.
摘要：
目的：下肢慢性劳累性室综合征（LE-CECS）可限制严格的体力活动，特别是在美国军队中，筋膜切开术是一种潜在的治疗方法。LE-CECS之间的关联，筋膜切开术,职业结果似乎被低估了。我们研究了美国现役军人，以确定LE-CECS的诊断和LE-CECS的筋膜切开术是否可以预测军事服务分离。
方法：我们对2011年至2017年期间服役的1,103,417人进行了一项回顾性队列研究。列出了分离状态和自变量的分布，和性别特异性多变量回归模型计算分离结果。
结果：LE-CECS与男性474％的医疗服务分离风险相关（调整风险比的95％置信区间（CI）：5.21至6.33），女性增加282％（CI：2.99至4.88）。在1947例LE-CECS患者中，当进行前室和/或侧室手术时,男性的非医疗分离风险增加了57%(CI:1.27~1.93),女性的非医疗分离风险增加了119%(CI:1.10~4.35).LE-CECS和任何后路手术的男性非医疗分离风险增加了47％（CI：1.17至1.86）。前和/或外侧手术以及任何后路手术的男性经历了36％（CI：1.09至1.71）和78％（CI：1.40至2.26）的医疗分离风险增加，分别。在其他情况下，女性的结局没有统计学上的显着风险增加。
结论：LE-CECS与兵役出院风险增加相关。在受影响的患者中，筋膜切开术对职业寿命没有积极影响.然而,筋膜切开术可以简单地作为最不可能继续服务的最难治性病例的标志。需要更多的研究来澄清因果途径，并确定可能从手术治疗中获得职业利益的患者。
方法：我们对2011年至2017年期间服役的1,103,417人进行了一项回顾性队列研究。列出了分离状态和自变量的分布，和性别特异性多变量回归模型计算分离结果。
结果：LE-CECS与男性474％的医疗服务分离风险相关（调整风险比的95％置信区间（CI）：5.21至6.33），女性增加282％（CI：2.99至4.88）。在1947例LE-CECS患者中，当进行前室和/或侧室手术时,男性的非医疗分离风险增加了57%(CI:1.27~1.93),女性的非医疗分离风险增加了119%(CI:1.10~4.35).LE-CECS和任何后路手术的男性非医疗分离风险增加了47％（CI：1.17至1.86）。前和/或外侧手术以及任何后路手术的男性经历了36％（CI：1.09至1.71）和78％（CI：1.40至2.26）的医疗分离风险增加，分别。在其他情况下，女性的结局没有统计学上的显着风险增加。
结论：LE-CECS与兵役出院风险增加相关。在受影响的患者中，筋膜切开术对职业寿命没有积极影响.然而,筋膜切开术可以简单地作为最不可能继续服务的最难治性病例的标志。需要更多的研究来澄清因果途径，并确定可能从手术治疗中获得职业利益的患者。
