骨科英文书籍精读（322）｜膝关节脱位（2）
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Treatment
Reduction under anaesthesia is urgent; this is usually achieved by pulling directly in the line of the leg, but hyperextension must be avoided because of the danger to the popliteal vessels. If reduction is achieved, the limb is rested on a back-splint and the circulation is checked repeatedly during the 48 hours. Because of swelling, a plaster cylinder is dangerous.
A vascular injury will need immediate repair and the limb is then more conveniently splinted with an anterior external fixator (Fig. 30.12). If possible, repair or reconstruction of the capsule and collateral ligaments should be undertaken at the same time – this may involve simple suture or reattachment of the avulsed portions to bone – in order to enable early movement of the knee with the support of a hinged knee brace. If the direct repair is tenuous, augmentation using tendon grafts may be needed.
In general, early reconstruction of the torn ligaments followed by protected movement of the joint reduces the severity of joint stiffness. The cruciate ligaments can be reconstructed after knee movement has recovered, usually some 6–12 months later. Prolonged cast immobilization (usually 12 weeks) is no longer recommended as it has been shown to be less good at preserving knee function.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
conveniently /kənˈviːniəntli/adv. 便利地；合宜地
hinged knee brace铰链膝关节支具
hinge /hɪndʒ/n. 铰链，折叶；关键，转折点
If the direct repair is tenuous, augmentation using tendon grafts may be needed. 如果直接修复是脆弱的，则可能需要使用肌腱移植进行增强。
tenuous /ˈtenjuəs/adj. 纤细的；稀薄的；贫乏的
augmentation /ˌɔːɡmenˈteɪʃn/n. 增加，增大；增加物
Prolonged cast immobilization (usually 12 weeks) is no longer recommended as it has been shown to be less good at preserving knee function.延长石膏固定(通常为12周)不再被推荐，因为它已被证明在保护膝关节功能方面不太好。
有道翻译（仅供参考，建议自己翻译）：
治疗
紧急麻醉下复位;这通常是通过直接在腿的直线拉动来实现的，但必须避免过度伸展，因为对腘血管有危险。
如果复位成功，则将肢体置于背夹板上，并在48小时内反复检查循环。由于肿胀，石膏筒是危险的。
血管损伤需要立即修复，然后使用anterior外固定架更方便地固定肢体(图30.12)。如果可能的话,胶囊和抵押品的修复或重建韧带应该同时进行,这可能涉及到简单的缝合或回贴抽出部分的骨头——为了使膝盖的早期运动的支持下铰链隅撑。如果直接修复是脆弱的，则可能需要使用肌腱移植进行增强。
一般来说，撕裂韧带的早期重建加上关节保护运动可以降低关节僵硬的严重程度。膝关节活动恢复后，通常在6-12个月后，可以重建交叉韧带。延长石膏固定(通常为12周)不再被推荐，因为它已被证明在保护膝关节功能方面不太好。