Dhar Dinesh
Orthopedics Department, Nizwa Regional Referral Hospital, Nizwa, Oman.
Oman Med J. 2015 Mar;30(2):e082. doi: 10.5001/omj.2015.32.
Snake bites are an important public health problem worldwide. Snake venom causes both systemic and local complications, which can prove fatal if not treated on time. The local effects of snake bite include tissue necrosis, edema, and compartment syndrome. Patients may also be left with permanent physical deformities due to residual sequelae of the snake bite. Compartment syndrome after a snake bite is an uncommon occurrence. The effects are more pronounced in children possibly due to the the reduced total dilution volume in children. The administration of anti-snake venom is the only specific therapy. Compartment syndrome occurs due to a vicious cycle of edema causing hypoxia and acidosis, which further increases capillary permeability and fluid extravasation. This results in a volume increase in the closed fascial compartment, which ultimately compromises circulation and causes irreversible muscle and nerve damage. Our report describes a case of upper limb compartment syndrome following a snake bite on the right wrist of a five-year-old girl who presented eight-hours after the snake bite to the emergency department of Nizwa Regional Referral Hospital. The patient received early and appropriate care but progressed to develop compartment syndrome for which she had to be taken to the operating theatre for emergency fasciotomy. All clinicians should be able to recognize the early symptoms and signs of an evolving compartment syndrome in absence of intracompartmental measuring equipment. The timely fasciotomy in our patient helped the patient achieve excellent functional results.
蛇咬伤是全球一个重要的公共卫生问题。蛇毒会引发全身和局部并发症,如果不及时治疗可能会致命。蛇咬伤的局部影响包括组织坏死、水肿和骨筋膜室综合征。由于蛇咬伤的残留后遗症,患者也可能会留下永久性身体畸形。蛇咬伤后的骨筋膜室综合征并不常见。这种影响在儿童中可能更为明显,可能是由于儿童的总稀释体积减少。注射抗蛇毒血清是唯一的特效疗法。骨筋膜室综合征是由于水肿导致缺氧和酸中毒的恶性循环引起的,这会进一步增加毛细血管通透性和液体外渗。这导致封闭的筋膜室内体积增加,最终损害血液循环并导致不可逆转的肌肉和神经损伤。我们的报告描述了一名五岁女孩右腕被蛇咬伤后出现上肢骨筋膜室综合征的病例,该女孩在被蛇咬伤八小时后到尼兹瓦地区转诊医院急诊科就诊。患者接受了早期且恰当的治疗,但仍进展为骨筋膜室综合征,为此她不得不被送往手术室进行紧急筋膜切开术。在没有室内测量设备的情况下,所有临床医生都应能够识别骨筋膜室综合征进展的早期症状和体征。我们患者的及时筋膜切开术帮助患者取得了出色的功能恢复结果。