Feasibility of ultrasound-guided osteofascial chamber puncture manometry in assessing the pressure of osteofascial chamber in patients with venomous snake bites_West China Medical Journal

Authors：

Lü Lin ¹ ,  XU Shuyun ¹ , TANG Shiyuan ¹ , JIANG Zhen ¹ , REN Yan ¹ , XIAN Xiaoyan ¹ , ZHOU Yue ¹ , CHEN Fang ² , BAI Ting ² , LI Yanan ² , HAN Cunqiao ² , DENG Di ¹

1. Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Emergency Medicine, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan 611700, P. R. China;

Corresponding?author：

XU Shuyun, Email: 120xsy@163.com

Keywords：

Venomous snake bite; osteofaseial compartment syndrome; pressure of osteofascial chamber; ultrasonic guidance; puncture; feasibility; security

DOI：

10.7507/1002-0179.202310090

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Objective To investigate the efficacy on clinical condition assessment and the safety of ultrasound-guided osteofascial chamber puncture manometry in evaluating the pressure of the osteofascial chamber in patients with venomous snake bites. Methods Patients with venomous snake bites admitted to the Department of Emergency Medicine of West China Hospital of Sichuan University between April 2021 and January 2023 were prospectively included, and their basic information, physiological indicators (heart rate, blood pressure), laboratory examination indicators, physical signs, treatment methods and prognosis were collected. The patients whose extremal pressure was measured by osteofascial chamber puncture under ultrasound guidance were selected as the manometry group. Patients who were bitten by venomous snakes at the same time without puncture pressure measurement were randomly selected as the control group at a ratio of 1∶1. The bleeding, infection, nerve injury, length of hospital stay and long-term prognosis of the two groups were compared to explore the safety of ultrasound-guided osteofascial chamber puncture manometry. The correlation between the pressure measured in the manometry group and creatine kinase (a representative index of acute poisoning severity score) was analyzed to explore the efficacy of ultrasound-guided osteofascial chamber puncture manometry in evaluating the disease. Results There was no significant difference between the manometry group and the control group in new or aggravated infection, bleeding, nerve injury (such as numbness and anesthesia), hospital treatment time, final detumescence time of the affected limb, or final adverse prognosis (P>0.05). There was a positive correlation between the measured pressure and creatine kinase (r_s=0.286, P=0.002). Conclusions The higher pressure measured by ultrasound-guided osteofascial chamber puncture manometry is, the more serious the poisoning condition may be. In addition, ultrasound-guided osteofascial chamber puncture manometry does not prolong the hospital time of patients or the final swelling reduction time of the affected limb, and does not increase the incidence of bleeding, infection, nerve damage or eventual adverse prognosis events. It has clinical practicability and feasibility.

Citation： Lü Lin, XU Shuyun, TANG Shiyuan, JIANG Zhen, REN Yan, XIAN Xiaoyan, ZHOU Yue, CHEN Fang, BAI Ting, LI Yanan, HAN Cunqiao, DENG Di. Feasibility of ultrasound-guided osteofascial chamber puncture manometry in assessing the pressure of osteofascial chamber in patients with venomous snake bites. West China Medical Journal, 2023, 38(11): 1673-1678. doi: 10.7507/1002-0179.202310090 Copy

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2.	Warrell DA, Williams DJ. Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet, 2023, 401(10385): 1382-1398.
3.	中國蛇傷救治專家共識專家組. 2018 年中國蛇傷救治專家共識. 蛇志, 2018, 30(4): 561-567.
4.	Bhaumik S, Beri D, Lassi ZS, et al. Interventions for the management of snakebite envenoming: an overview of systematic reviews. PLoS Negl Trop Dis, 2020, 14(10): e0008727.
5.	劉明華, 文亮, 孫溦, 等. 毒蛇咬傷并發骨筋膜室綜合征臨床防治分析. 中國急救醫學, 2007(10): 898-900.
6.	周輝輝. 毒蛇咬傷致骨筋膜室綜合征的急救與護理. 蛇志, 2015, 27(4): 448-449.
7.	Harper S, Buckley C, Sanscartier S, et al. EE260. An early cost-effectiveness analysis of a new continuous compartment pressure monitoring device in tibial fracture patients who are at risk of developing acute compartment syndrome (ACS). Value in Health, 2022, 25(12S): S104.
8.	Beniwal RK, Bansal A. Osteofascial compartment pressure measurement in closed limb injuries – Whitesides’ technique revisited. J Clin Orthop Trauma, 2016, 7(4): 225-228.
9.	程建文, 鄧思煜, 蘇偉. 改良垂直水柱測壓在急性骨筋膜室綜合征臨床防治中的應用. 廣西醫科大學學報, 2020, 37(7): 1307-1312.
10.	蘇偉, 趙勁民, 張斌, 等. 垂直水柱測壓法與 Whiteside 法診斷骨筋膜室綜合征的實驗研究. 中國矯形外科雜志, 2010, 18(22): 1896-1898.
11.	Wu Y, Luo L, Niu T, et al. Evaluation of the new Chinese Disseminated Intravascular Coagulation Scoring System in critically ill patients: a multicenter prospective study. Sci Rep, 2017, 7(1): 9057.
12.	Garner MR, Taylor SA, Gausden E, et al. Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century. HSS J, 2014, 10(2): 143-152.
13.	von Keudell AG, Weaver MJ, Appleton PT, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet, 2015, 386(10000): 1299-1310.
14.	杜建航, 康展榮, 黃利彪, 等. 骨筋膜室綜合征的病理生理機制及診斷研究進展. 創傷外科雜志, 2021, 23(3): 231-234.
15.	Persson HE, Sj?berg GK, Haines JA, et al. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol, 1998, 36(3): 205-213.
16.	Valdez C, Schroeder E, Amdur R, et al. Serum creatine kinase levels are associated with extremity compartment syndrome. J Trauma Acute Care Surg, 2013, 74(2): 441-445.
17.	Zhang D, Janssen SJ, Tarabochia M, et al. Factors associated with poor outcomes in acute forearm compartment syndrome. Hand (N Y), 2021, 16(5): 679-685.
18.	Bawaskar HS, Bawaskar PH. Snakebite envenoming. Lancet, 2019, 393(10167): 131.
19.	Guo J, Yin Y, Jin L, et al. Acute compartment syndrome: cause, diagnosis, and new viewpoint. Medicine (Baltimore), 2019, 98(27): e16260.
20.	Schmidt AH. Acute compartment syndrome. Injury, 2017, 48(Suppl 1): S22-S25.
21.	蔡波, 呂可, 陳躍英, 等. 四川省兩棲爬行動物分布名錄. 中國科學數據(中英文網絡版), 2018, 3(1): 11-19.
22.	覃公平. 中國毒蛇學. 2 版. 南寧: 廣西科技出版社, 1999: 45.
23.	Bohlmeyer TJ, Wu AH, Perryman MB. Evaluation of laboratory tests as a guide to diagnosis and therapy of myositis. Rheum Dis Clin North Am, 1994, 20(4): 845-856.
24.	Bessman SP, Carpenter CL. The creatine-creatine phosphate energy shuttle. Annu Rev Biochem, 1985, 54: 831-862.
25.	楊國成, 趙海濤, 馬梁策, 等. 毒蛇咬傷創面感染的影響因素及其預測模型. 中華醫院感染學雜志, 2023, 33(17): 2688-2692.
26.	游靖宇, 劉少云, 張茂. 急性骨筋膜室綜合征的診治研究進展. 創傷外科雜志, 2020, 22(6): 470-473.
27.	Leversedge FJ, Moore TJ, Peterson BC, et al. Compartment syndrome of the upper extremity. J Hand Surg Am, 2011, 36(3): 544-559.
28.	龍盛雙, 王瑞烈, 周滿紅, 等. 從蛇咬傷并發骨筋膜室綜合征談蛇咬傷的急診救治. 遵義醫學院學報, 2007, 30(1): 52-53.

1. Seifert SA, Armitage JO, Sanchez EE. Snake envenomation. N Engl J Med, 2022, 386(1): 68-78.
2. Warrell DA, Williams DJ. Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet, 2023, 401(10385): 1382-1398.
3. 中國蛇傷救治專家共識專家組. 2018 年中國蛇傷救治專家共識. 蛇志, 2018, 30(4): 561-567.
4. Bhaumik S, Beri D, Lassi ZS, et al. Interventions for the management of snakebite envenoming: an overview of systematic reviews. PLoS Negl Trop Dis, 2020, 14(10): e0008727.
5. 劉明華, 文亮, 孫溦, 等. 毒蛇咬傷并發骨筋膜室綜合征臨床防治分析. 中國急救醫學, 2007(10): 898-900.
6. 周輝輝. 毒蛇咬傷致骨筋膜室綜合征的急救與護理. 蛇志, 2015, 27(4): 448-449.
7. Harper S, Buckley C, Sanscartier S, et al. EE260. An early cost-effectiveness analysis of a new continuous compartment pressure monitoring device in tibial fracture patients who are at risk of developing acute compartment syndrome (ACS). Value in Health, 2022, 25(12S): S104.
8. Beniwal RK, Bansal A. Osteofascial compartment pressure measurement in closed limb injuries – Whitesides’ technique revisited. J Clin Orthop Trauma, 2016, 7(4): 225-228.
9. 程建文, 鄧思煜, 蘇偉. 改良垂直水柱測壓在急性骨筋膜室綜合征臨床防治中的應用. 廣西醫科大學學報, 2020, 37(7): 1307-1312.
10. 蘇偉, 趙勁民, 張斌, 等. 垂直水柱測壓法與 Whiteside 法診斷骨筋膜室綜合征的實驗研究. 中國矯形外科雜志, 2010, 18(22): 1896-1898.
11. Wu Y, Luo L, Niu T, et al. Evaluation of the new Chinese Disseminated Intravascular Coagulation Scoring System in critically ill patients: a multicenter prospective study. Sci Rep, 2017, 7(1): 9057.
12. Garner MR, Taylor SA, Gausden E, et al. Compartment syndrome: diagnosis, management, and unique concerns in the twenty-first century. HSS J, 2014, 10(2): 143-152.
13. von Keudell AG, Weaver MJ, Appleton PT, et al. Diagnosis and treatment of acute extremity compartment syndrome. Lancet, 2015, 386(10000): 1299-1310.
14. 杜建航, 康展榮, 黃利彪, 等. 骨筋膜室綜合征的病理生理機制及診斷研究進展. 創傷外科雜志, 2021, 23(3): 231-234.
15. Persson HE, Sj?berg GK, Haines JA, et al. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin Toxicol, 1998, 36(3): 205-213.
16. Valdez C, Schroeder E, Amdur R, et al. Serum creatine kinase levels are associated with extremity compartment syndrome. J Trauma Acute Care Surg, 2013, 74(2): 441-445.
17. Zhang D, Janssen SJ, Tarabochia M, et al. Factors associated with poor outcomes in acute forearm compartment syndrome. Hand (N Y), 2021, 16(5): 679-685.
18. Bawaskar HS, Bawaskar PH. Snakebite envenoming. Lancet, 2019, 393(10167): 131.
19. Guo J, Yin Y, Jin L, et al. Acute compartment syndrome: cause, diagnosis, and new viewpoint. Medicine (Baltimore), 2019, 98(27): e16260.
20. Schmidt AH. Acute compartment syndrome. Injury, 2017, 48(Suppl 1): S22-S25.
21. 蔡波, 呂可, 陳躍英, 等. 四川省兩棲爬行動物分布名錄. 中國科學數據(中英文網絡版), 2018, 3(1): 11-19.
22. 覃公平. 中國毒蛇學. 2 版. 南寧: 廣西科技出版社, 1999: 45.
23. Bohlmeyer TJ, Wu AH, Perryman MB. Evaluation of laboratory tests as a guide to diagnosis and therapy of myositis. Rheum Dis Clin North Am, 1994, 20(4): 845-856.
24. Bessman SP, Carpenter CL. The creatine-creatine phosphate energy shuttle. Annu Rev Biochem, 1985, 54: 831-862.
25. 楊國成, 趙海濤, 馬梁策, 等. 毒蛇咬傷創面感染的影響因素及其預測模型. 中華醫院感染學雜志, 2023, 33(17): 2688-2692.
26. 游靖宇, 劉少云, 張茂. 急性骨筋膜室綜合征的診治研究進展. 創傷外科雜志, 2020, 22(6): 470-473.
27. Leversedge FJ, Moore TJ, Peterson BC, et al. Compartment syndrome of the upper extremity. J Hand Surg Am, 2011, 36(3): 544-559.
28. 龍盛雙, 王瑞烈, 周滿紅, 等. 從蛇咬傷并發骨筋膜室綜合征談蛇咬傷的急診救治. 遵義醫學院學報, 2007, 30(1): 52-53.

West China Medical Journal

Feasibility of ultrasound-guided osteofascial chamber puncture manometry in assessing the pressure of osteofascial chamber in patients with venomous snake bites

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