Research progress on acute compartment syndrome caused by snake bites_West China Medical Journal

Authors：

SONG Yalan ¹ , MA Zengwen ² ,  XU Shuyun ² , QIAN Weiwei ² , ZHOU Yue ² , TONG Jiale ²

1. Department of Emergency Medicine, Chengdu Shang Jin Nan Fu Hospital, Chengdu, Sichuan 611700, P. R. China;
2. Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

XU Shuyun, Email: 120xsy@163.com

Keywords：

Snake bite; acute compartment syndrome; intracompartmental pressure

DOI：

10.7507/1002-0179.202406266

Video：

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Acute compartment syndrome (ACS) is one of the serious complications of snake bites, which can lead to amputation or even death in severe cases. Early diagnosis and treatment of ACS remain a major challenge. This paper focuses on the latest research trends in early diagnosis of ACS, with an emphasis on the application of emerging monitoring technologies in critical areas such as intercompartmental pressure measurement, oxygenation monitoring, and perfusion monitoring. It also provides a comprehensive analysis of diverse treatment strategies including surgical and conservative interventions, aiming to offer more precise diagnostic and treatment guidelines for clinical practitioners.

Citation： SONG Yalan, MA Zengwen, XU Shuyun, QIAN Weiwei, ZHOU Yue, TONG Jiale. Research progress on acute compartment syndrome caused by snake bites. West China Medical Journal, 2024, 39(11): 1797-1801. doi: 10.7507/1002-0179.202406266 Copy

1.	颜时姣, 胡燕兰, 王选岩, 等. 中国蛇伤诊疗现状与展望. 中华急诊医学杂志, 2024, 33(3): 281-285.
2.	Mortensen SJ, Vora MM, Mohamadi A, et al. Diagnostic modalities for acute compartment syndrome of the extremities: a systematic review. JAMA Surg, 2019, 154(7): 655-665.
3.	Osborn CPM, Schmidt AH. Management of acute compartment syndrome. J Am Acad Orthop Surg, 2020, 28(3): e108-e114.
4.	Nudel I, Dorfmann L, deBotton G. The compartment syndrome: is the intra-compartment pressure a reliable indicator for early diagnosis?. Math Med Biol, 2017, 34(4): 547-558.
5.	Guo J, Yin Y, Jin L, et al. Acute compartment syndrome: cause, diagnosis, and new viewpoint. Medicine (Baltimore), 2019, 98(27): e16260.
6.	吕林, 许树云, 唐时元, 等. 超声引导下骨筋膜室穿刺测压用于评估毒蛇咬伤患者骨筋膜室压力的可行性研究. 华西医学, 2023, 38(11): 1673-1678.
7.	Schupbach D, Reindl R, Gill HL, et al. Continuous compartment pressure monitoring allows the early detection of compartment syndrome after arterial revascularization. Cureus, 2024, 16(3): e55451.
8.	Merle G, Comeau-Gauthier M, Tayari V, et al. Comparison of three devices to measure pressure for acute compartment syndrome. Mil Med, 2020, 185(Suppl 1): 77-81.
9.	Leighton R, Balhareth M. Clinical trial of a new device for real-time muscle pressure measurements in patients with an upper or lower extremity fracture at risk for acute compartment syndrome. Orthop Procs, 2022, 104-B(SUPP_13): 108.
10.	McMillan TE, Gardner WT, Schmidt AH, et al. Diagnosing acute compartment syndrome-where have we got to?. Int Orthop, 2019, 43(11): 2429-2435.
11.	Schmidt AH, Di J, Zipunnikov V, et al. Perfusion pressure lacks diagnostic specificity for the diagnosis of acute compartment syndrome. J Orthop Trauma, 2020, 34(6): 287-293.
12.	Weick JW, Kang H, Lee L, et al. Direct measurement of tissue oxygenation as a method of diagnosis of acute compartment syndrome. J Orthop Trauma, 2016, 30(11): 585-591.
13.	Barstow TJ. Understanding near infrared spectroscopy and its application to skeletal muscle research. J Appl Physiol (1985), 2019, 126(5): 1360-1376.
14.	Novak M, Penhaker M, Raska P, et al. Extremity compartment syndrome: a review with a focus on non-invasive methods of diagnosis. Front Bioeng Biotechnol, 2022, 10: 801586.
15.	Westman AM, Guo H, Xu Y, et al. Percutaneously introduced wireless intramuscular near-infrared spectroscopy device detects muscle oxygenation changes in porcine model of lower extremity compartment syndrome. J Orthop Res, 2023, 41(1): 54-62.
16.	Witthauer L, Cascales JP, Roussakis E, et al. Portable oxygen-sensing device for the improved assessment of compartment syndrome and other hypoxia-related conditions. ACS Sens, 2021, 6(1): 43-53.
17.	Ho CH, Ismail AK, Liu SH, et al. The role of a point-of-care ultrasound protocol in facilitating clinical decisions for snakebite envenomation in Taiwan: a pilot study. Clin Toxicol (Phila), 2021, 59(9): 794-800.
18.	Hou YT, Chang MC, Yang C, et al. Prediction of compartment syndrome after protobothrops mucrosquamatus snakebite by diastolic retrograde arterial flow: a case report. Medicina (Kaunas), 2022, 58(8): 996.
19.	Sellei RM, Wollnitz J, Reinhardt N, et al. Non-invasive measurement of muscle compartment elasticity in lower limbs to determine acute compartment syndrome: clinical results with pressure related ultrasound. Injury, 2020, 51(2): 301-306.
20.	Shalabi HT, Lincoln EJ, Shalabi ST, et al. Early diagnosis of acute compartment syndrome using green light reflectance photoplethysmography. J Am Coll Surg, 2014, 219(4): e187-e188.
21.	Ohta H, Vo NV, Hata J, et al. Utilizing dynamic phosphorous-31 magnetic resonance spectroscopy for the early detection of acute compartment syndrome: a pilot study on rats. Diagnostics (Basel), 2021, 11(4): 586.
22.	Yıldırım A, Önal İÖ, Çelik ZE, et al. Early assessment of extremity compartment syndrome by biochemical markers in a rat model. Turk J Med Sci, 2023, 53(1): 1-9.
23.	Large TM, Agel J, Holtzman DJ, et al. Interobserver variability in the measurement of lower leg compartment pressures. J Orthop Trauma, 2015, 29(7): 316-321.
24.	Valente-Aguiar MS, Gonçalves da Costa E Silva B, Magalhães T, et al. Compartment syndrome following bothrops snakebite leads to decompressive fasciotomies. Case Rep Med, 2019, 2019: 6324569.
25.	Lee SH, Padilla M, Lynch JE, et al. Noninvasive measurements of pressure for detecting compartment syndromes. J Orthop Rheumatol, 2013, 1(1): 5.
26.	Long B, Koyfman A, Gottlieb M. Evaluation and management of acute compartment syndrome in the emergency department. J Emerg Med, 2019, 56(4): 386-397.
27.	Schmidt AH. Acute compartment syndrome. Orthop Clin North Am, 2016, 47(3): 517-525.
28.	Osborn PM, Schmidt AH. Diagnosis and management of acute compartment syndrome. J Am Acad Orthop Surg, 2021, 29(5): 183-188.
29.	Bucaretchi F, de Capitani EM, Hyslop S, et al. Compartment syndrome after Bothrops jararaca snakebite: monitoring, treatment, and outcome. Clin Toxicol (Phila), 2010, 48(1): 57-60.
30.	Greene S, Cheng D, Vilke GM, et al. How should native crotalid envenomation be managed in the emergency department?. J Emerg Med, 2021, 61(1): 41-48.
31.	Türkmen A, Temel M. Algorithmic approach to the prevention of unnecessary fasciotomy in extremity snake bite. Injury, 2016, 47(12): 2822-2827.
32.	谢振兴, 白祥军, 王伟阳. 不同负压封闭引流负压值对创面愈合的影响. 创伤外科杂志, 2020, 22(7): 507-512.
33.	Varney SM, Alindogan AA, Stuteville H, et al. Fasciotomy following North American pit viper envenomation in Texas 2004-2021. Clin Toxicol (Phila), 2024, 62(5): 314-321.
34.	朱元州, 杜宇, 荣霞. 毒蛇致伤临床诊治专家共识. 巴楚医学, 2023, 6(4): 1-13.
35.	陈海东, 张炎安. 血液灌流联合抗蛇毒血清对蛇咬伤所致急性重症患者的疗效. 蛇志, 2019, 31(3): 322-324.
36.	陈冰冰, 高萍, 冷英杰, 等. 持续缓慢低效血液透析串联血液灌流疗法联合综合护理模式在蝮蛇咬伤中的效果观察. 蛇志, 2023, 35(3): 316-319, 375.
37.	代洪媛, 李声凤, 兰秀君, 等. 高压氧辅助抗蛇毒血清对早期蝮蛇咬伤中毒患者患肢肿胀情况、心肌酶谱、炎症因子水平改变的影响. 分子诊断与治疗杂志, 2024, 16(2): 220-224.
38.	Korambayil PM, Ambookan PV, Abraham SV, et al. A multidisciplinary approach with hyperbaric oxygen therapy improve outcome in snake bite injuries. Toxicol Int, 2015, 22(1): 104-109.
39.	彭清生, 付芬, 周冬龙. 蓝光照射治疗蝮蛇咬伤效果分析. 中国烧伤创疡杂志, 2024, 36(3): 201-204.
40.	李国强, 韩宁林, 曹承楼, 等. 中医外治法辅助治疗蝮蛇咬伤肢体的临床观察. 中国中医急症, 2020, 29(11): 2002-2004.
41.	任金平, 袁丞达, 应航宇. 邬氏清热解毒方对竹叶青蛇咬伤患者肢体肿胀及凝血功能的影响. 中国中医药科技, 2023, 30(3): 496-498.
42.	陈俊. 717 解毒合剂治疗蝮蛇咬伤的临床及实验研究. 南昌: 江西中医药大学, 2021.

1. 颜时姣, 胡燕兰, 王选岩, 等. 中国蛇伤诊疗现状与展望. 中华急诊医学杂志, 2024, 33(3): 281-285.
2. Mortensen SJ, Vora MM, Mohamadi A, et al. Diagnostic modalities for acute compartment syndrome of the extremities: a systematic review. JAMA Surg, 2019, 154(7): 655-665.
3. Osborn CPM, Schmidt AH. Management of acute compartment syndrome. J Am Acad Orthop Surg, 2020, 28(3): e108-e114.
4. Nudel I, Dorfmann L, deBotton G. The compartment syndrome: is the intra-compartment pressure a reliable indicator for early diagnosis?. Math Med Biol, 2017, 34(4): 547-558.
5. Guo J, Yin Y, Jin L, et al. Acute compartment syndrome: cause, diagnosis, and new viewpoint. Medicine (Baltimore), 2019, 98(27): e16260.
6. 吕林, 许树云, 唐时元, 等. 超声引导下骨筋膜室穿刺测压用于评估毒蛇咬伤患者骨筋膜室压力的可行性研究. 华西医学, 2023, 38(11): 1673-1678.
7. Schupbach D, Reindl R, Gill HL, et al. Continuous compartment pressure monitoring allows the early detection of compartment syndrome after arterial revascularization. Cureus, 2024, 16(3): e55451.
8. Merle G, Comeau-Gauthier M, Tayari V, et al. Comparison of three devices to measure pressure for acute compartment syndrome. Mil Med, 2020, 185(Suppl 1): 77-81.
9. Leighton R, Balhareth M. Clinical trial of a new device for real-time muscle pressure measurements in patients with an upper or lower extremity fracture at risk for acute compartment syndrome. Orthop Procs, 2022, 104-B(SUPP_13): 108.
10. McMillan TE, Gardner WT, Schmidt AH, et al. Diagnosing acute compartment syndrome-where have we got to?. Int Orthop, 2019, 43(11): 2429-2435.
11. Schmidt AH, Di J, Zipunnikov V, et al. Perfusion pressure lacks diagnostic specificity for the diagnosis of acute compartment syndrome. J Orthop Trauma, 2020, 34(6): 287-293.
12. Weick JW, Kang H, Lee L, et al. Direct measurement of tissue oxygenation as a method of diagnosis of acute compartment syndrome. J Orthop Trauma, 2016, 30(11): 585-591.
13. Barstow TJ. Understanding near infrared spectroscopy and its application to skeletal muscle research. J Appl Physiol (1985), 2019, 126(5): 1360-1376.
14. Novak M, Penhaker M, Raska P, et al. Extremity compartment syndrome: a review with a focus on non-invasive methods of diagnosis. Front Bioeng Biotechnol, 2022, 10: 801586.
15. Westman AM, Guo H, Xu Y, et al. Percutaneously introduced wireless intramuscular near-infrared spectroscopy device detects muscle oxygenation changes in porcine model of lower extremity compartment syndrome. J Orthop Res, 2023, 41(1): 54-62.
16. Witthauer L, Cascales JP, Roussakis E, et al. Portable oxygen-sensing device for the improved assessment of compartment syndrome and other hypoxia-related conditions. ACS Sens, 2021, 6(1): 43-53.
17. Ho CH, Ismail AK, Liu SH, et al. The role of a point-of-care ultrasound protocol in facilitating clinical decisions for snakebite envenomation in Taiwan: a pilot study. Clin Toxicol (Phila), 2021, 59(9): 794-800.
18. Hou YT, Chang MC, Yang C, et al. Prediction of compartment syndrome after protobothrops mucrosquamatus snakebite by diastolic retrograde arterial flow: a case report. Medicina (Kaunas), 2022, 58(8): 996.
19. Sellei RM, Wollnitz J, Reinhardt N, et al. Non-invasive measurement of muscle compartment elasticity in lower limbs to determine acute compartment syndrome: clinical results with pressure related ultrasound. Injury, 2020, 51(2): 301-306.
20. Shalabi HT, Lincoln EJ, Shalabi ST, et al. Early diagnosis of acute compartment syndrome using green light reflectance photoplethysmography. J Am Coll Surg, 2014, 219(4): e187-e188.
21. Ohta H, Vo NV, Hata J, et al. Utilizing dynamic phosphorous-31 magnetic resonance spectroscopy for the early detection of acute compartment syndrome: a pilot study on rats. Diagnostics (Basel), 2021, 11(4): 586.
22. Yıldırım A, Önal İÖ, Çelik ZE, et al. Early assessment of extremity compartment syndrome by biochemical markers in a rat model. Turk J Med Sci, 2023, 53(1): 1-9.
23. Large TM, Agel J, Holtzman DJ, et al. Interobserver variability in the measurement of lower leg compartment pressures. J Orthop Trauma, 2015, 29(7): 316-321.
24. Valente-Aguiar MS, Gonçalves da Costa E Silva B, Magalhães T, et al. Compartment syndrome following bothrops snakebite leads to decompressive fasciotomies. Case Rep Med, 2019, 2019: 6324569.
25. Lee SH, Padilla M, Lynch JE, et al. Noninvasive measurements of pressure for detecting compartment syndromes. J Orthop Rheumatol, 2013, 1(1): 5.
26. Long B, Koyfman A, Gottlieb M. Evaluation and management of acute compartment syndrome in the emergency department. J Emerg Med, 2019, 56(4): 386-397.
27. Schmidt AH. Acute compartment syndrome. Orthop Clin North Am, 2016, 47(3): 517-525.
28. Osborn PM, Schmidt AH. Diagnosis and management of acute compartment syndrome. J Am Acad Orthop Surg, 2021, 29(5): 183-188.
29. Bucaretchi F, de Capitani EM, Hyslop S, et al. Compartment syndrome after Bothrops jararaca snakebite: monitoring, treatment, and outcome. Clin Toxicol (Phila), 2010, 48(1): 57-60.
30. Greene S, Cheng D, Vilke GM, et al. How should native crotalid envenomation be managed in the emergency department?. J Emerg Med, 2021, 61(1): 41-48.
31. Türkmen A, Temel M. Algorithmic approach to the prevention of unnecessary fasciotomy in extremity snake bite. Injury, 2016, 47(12): 2822-2827.
32. 谢振兴, 白祥军, 王伟阳. 不同负压封闭引流负压值对创面愈合的影响. 创伤外科杂志, 2020, 22(7): 507-512.
33. Varney SM, Alindogan AA, Stuteville H, et al. Fasciotomy following North American pit viper envenomation in Texas 2004-2021. Clin Toxicol (Phila), 2024, 62(5): 314-321.
34. 朱元州, 杜宇, 荣霞. 毒蛇致伤临床诊治专家共识. 巴楚医学, 2023, 6(4): 1-13.
35. 陈海东, 张炎安. 血液灌流联合抗蛇毒血清对蛇咬伤所致急性重症患者的疗效. 蛇志, 2019, 31(3): 322-324.
36. 陈冰冰, 高萍, 冷英杰, 等. 持续缓慢低效血液透析串联血液灌流疗法联合综合护理模式在蝮蛇咬伤中的效果观察. 蛇志, 2023, 35(3): 316-319, 375.
37. 代洪媛, 李声凤, 兰秀君, 等. 高压氧辅助抗蛇毒血清对早期蝮蛇咬伤中毒患者患肢肿胀情况、心肌酶谱、炎症因子水平改变的影响. 分子诊断与治疗杂志, 2024, 16(2): 220-224.
38. Korambayil PM, Ambookan PV, Abraham SV, et al. A multidisciplinary approach with hyperbaric oxygen therapy improve outcome in snake bite injuries. Toxicol Int, 2015, 22(1): 104-109.
39. 彭清生, 付芬, 周冬龙. 蓝光照射治疗蝮蛇咬伤效果分析. 中国烧伤创疡杂志, 2024, 36(3): 201-204.
40. 李国强, 韩宁林, 曹承楼, 等. 中医外治法辅助治疗蝮蛇咬伤肢体的临床观察. 中国中医急症, 2020, 29(11): 2002-2004.
41. 任金平, 袁丞达, 应航宇. 邬氏清热解毒方对竹叶青蛇咬伤患者肢体肿胀及凝血功能的影响. 中国中医药科技, 2023, 30(3): 496-498.
42. 陈俊. 717 解毒合剂治疗蝮蛇咬伤的临床及实验研究. 南昌: 江西中医药大学, 2021.

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