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.	顏時姣, 胡燕蘭, 王選巖, 等. 中國蛇傷診療現狀與展望. 中華急診醫學雜志, 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.	呂林, 許樹云, 唐時元, 等. 超聲引導下骨筋膜室穿刺測壓用于評估毒蛇咬傷患者骨筋膜室壓力的可行性研究. 華西醫學, 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.	Y?ld?r?m A, ?nal ??, ?elik 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, Gon?alves da Costa E Silva B, Magalh?es 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.	謝振興, 白祥軍, 王偉陽. 不同負壓封閉引流負壓值對創面愈合的影響. 創傷外科雜志, 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, 榮霞. 毒蛇致傷臨床診治專家共識. 巴楚醫學, 2023, 6(4): 1-13.
35.	陳海東, 張炎安. 血液灌流聯合抗蛇毒血清對蛇咬傷所致急性重癥患者的療效. 蛇志, 2019, 31(3): 322-324.
36.	陳冰冰, 高萍, 冷英杰, 等. 持續緩慢低效血液透析串聯血液灌流療法聯合綜合護理模式在蝮蛇咬傷中的效果觀察. 蛇志, 2023, 35(3): 316-319, 375.
37.	代洪媛, 李聲鳳, 蘭秀君, 等. 高壓氧輔助抗蛇毒血清對早期蝮蛇咬傷中毒患者患肢腫脹情況、心肌酶譜、炎癥因子水平改變的影響. 分子診斷與治療雜志, 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, 周冬龍. 藍光照射治療蝮蛇咬傷效果分析. 中國燒傷創瘍雜志, 2024, 36(3): 201-204.
40.	李國強, 韓寧林, 曹承樓, 等. 中醫外治法輔助治療蝮蛇咬傷肢體的臨床觀察. 中國中醫急癥, 2020, 29(11): 2002-2004.
41.	任金平, 袁丞達, 應航宇. 鄔氏清熱解毒方對竹葉青蛇咬傷患者肢體腫脹及凝血功能的影響. 中國中醫藥科技, 2023, 30(3): 496-498.
42.	陳俊. 717 解毒合劑治療蝮蛇咬傷的臨床及實驗研究. 南昌: 江西中醫藥大學, 2021.

1. 顏時姣, 胡燕蘭, 王選巖, 等. 中國蛇傷診療現狀與展望. 中華急診醫學雜志, 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. 呂林, 許樹云, 唐時元, 等. 超聲引導下骨筋膜室穿刺測壓用于評估毒蛇咬傷患者骨筋膜室壓力的可行性研究. 華西醫學, 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. Y?ld?r?m A, ?nal ??, ?elik 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, Gon?alves da Costa E Silva B, Magalh?es 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. 謝振興, 白祥軍, 王偉陽. 不同負壓封閉引流負壓值對創面愈合的影響. 創傷外科雜志, 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, 榮霞. 毒蛇致傷臨床診治專家共識. 巴楚醫學, 2023, 6(4): 1-13.
35. 陳海東, 張炎安. 血液灌流聯合抗蛇毒血清對蛇咬傷所致急性重癥患者的療效. 蛇志, 2019, 31(3): 322-324.
36. 陳冰冰, 高萍, 冷英杰, 等. 持續緩慢低效血液透析串聯血液灌流療法聯合綜合護理模式在蝮蛇咬傷中的效果觀察. 蛇志, 2023, 35(3): 316-319, 375.
37. 代洪媛, 李聲鳳, 蘭秀君, 等. 高壓氧輔助抗蛇毒血清對早期蝮蛇咬傷中毒患者患肢腫脹情況、心肌酶譜、炎癥因子水平改變的影響. 分子診斷與治療雜志, 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, 周冬龍. 藍光照射治療蝮蛇咬傷效果分析. 中國燒傷創瘍雜志, 2024, 36(3): 201-204.
40. 李國強, 韓寧林, 曹承樓, 等. 中醫外治法輔助治療蝮蛇咬傷肢體的臨床觀察. 中國中醫急癥, 2020, 29(11): 2002-2004.
41. 任金平, 袁丞達, 應航宇. 鄔氏清熱解毒方對竹葉青蛇咬傷患者肢體腫脹及凝血功能的影響. 中國中醫藥科技, 2023, 30(3): 496-498.
42. 陳俊. 717 解毒合劑治療蝮蛇咬傷的臨床及實驗研究. 南昌: 江西中醫藥大學, 2021.

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