Hardwicke J, Srivastava S
University Hospitals of Coventry and Warwickshire NHS Trust, UK.
Ann R Coll Surg Engl. 2013 Mar;95(2):e36-7. doi: 10.1308/003588413X13511609955210.
Compartment syndrome affecting the upper limb is reported rarely in the literature and is usually limited to single case reports. Upper limb compartment syndrome secondary to envenomation is rare, especially in the UK. Worldwide, it has been reported resulting from snake and insect bites, mostly from snakes from the Viperidae family, and from insects such as bees and wasps. Reports from the UK are limited to one case of an adder bite. We present a case of a previously fit and well adult who developed an ischaemic contracture of the forearm after an insect bite. Surgical exploration revealed segmental necrosis and contracture of the superficial and deep flexors of the fingers, requiring fasciotomy and tendon-lengthening procedures. This is the first report of a compartment syndrome, or a late ischaemic contracture from an insect bite in the UK. Owing to the rarity of compartment syndrome of the upper limb secondary to envenomation, a delay in diagnosis and treatment can lead to irreversible changes in the muscular compartments of the forearm.
上肢骨筋膜室综合征在文献中的报道很少,通常仅限于个案报告。由中毒引起的上肢骨筋膜室综合征很罕见,在英国尤其如此。在全球范围内,有报道称其由蛇和昆虫叮咬导致,主要是蝰蛇科的蛇,以及蜜蜂和黄蜂等昆虫。英国的报告仅限于一例蝰蛇咬伤病例。我们报告一例既往健康的成年人,在昆虫叮咬后出现前臂缺血性挛缩。手术探查发现手指浅、深屈肌节段性坏死和挛缩,需要进行筋膜切开术和肌腱延长手术。这是英国首例关于昆虫叮咬导致骨筋膜室综合征或晚期缺血性挛缩的报告。由于中毒继发上肢骨筋膜室综合征罕见,诊断和治疗的延迟可能导致前臂肌肉间隔发生不可逆变化。