骨科英文书籍精读（242）｜股骨颈骨折骨不连
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Non-union
More than 30 per cent of all femoral neck fractures fail to unite, and the risk is particularly high in those that are severely displaced. There are many causes: poor blood supply, imperfect reduction, inadequate fixation, and the tardy healing that is characteristic of intra-articular fractures. The bone at the fracture site is ground away, the fragments fall apart and the screw cuts out of the bone or is extruded laterally. The patient complains of pain, shortening of the limb and difficulty with walking. The x-ray shows the sorry outcome.
The method of treatment depends on the cause of the non-union and the age of the patient. In the relatively young, three procedures are available: (1) if the fracture is nearly vertical but the head is alive, subtrochanteric osteotomy with internal fixation changes the fracture line to a more horizontal angle; (2) if the reduction or fixation was faulty and there are no signs of necrosis, it is reasonable to remove the screws, reduce the fracture, insert fresh screws correctly and also to apply a bone graft across the fracture, either a segment of fibula or a muscle pedicle graft; and (3), if the head is avascular but the joint unaffected, prosthetic replacement may be suitable; if the joint is damaged or arthritic, total replacement is indicated.
In elderly patients, only two procedures should be considered: (1) if pain is considerable then the femoral head, no matter whether it is avascular or not, is best removed and (provided the patient is reasonably fit) total joint replacement is performed; (2) if the patient is old and infirm and pain not unbearable, a raised heel and a stout stick or elbow crutch are often sufficient.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
tardy/ˈtɑːrdi/n. 迟到adj. 缓慢的，迟缓的；迟到的
The bone at the fracture site is ground away骨折处的骨头被磨掉了
extruded /ɪkˈstruːdɪd/adj. 压出的；受挤压的v. 使…喷出；使伸出；驱逐（extrude的过去分词）
The x-ray shows the sorry outcome.x光片显示结果很糟糕。
In the relatively young, three procedures are available.对于相对年轻的患者，有三种治疗方法:
vertical /ˈvɜːrtɪkl/adj. 垂直的，直立的；
horizontal /ˌhɔːrɪˈzɑːntl/n. 水平线，水平面；水平位置adj. 水平的；地平线的；同一阶层的
either a segment of fibula or a muscle pedicle graft腓骨的一段或肌肉蒂移植物
pedicle /ˈpedɪkl/n. 蒂；[动] 肉茎；花梗
considerable/kənˈsɪdərəbl/adj. 相当大的；重要的，值得考虑的
infirm /ɪnˈfɜːrm/adj. 衰弱的；意志薄弱的；不坚固的
provided /prəˈvaɪdɪd/conj. 假如，倘若v. 提供，给予（provide 的过去式和过去分词）
百度翻译：
骨不连
超过30%的股骨颈骨折不能愈合，严重移位的股骨颈骨折风险特别高。原因有很多：血供不足，复位不全，固定不充分，关节内骨折愈合缓慢。骨折处的骨头被磨掉，碎片散开，螺钉从骨头中切出或横向挤压。病人抱怨疼痛、四肢缩短和行走困难。x光片显示了令人遗憾的结果。
治疗方法取决于不愈合的原因和患者的年龄。对于相对年轻的患者，有三种方法可供选择：（1）如果骨折几乎垂直，但头部是活的，转子下截骨加内固定可使骨折线变为更水平的角度；（2）如果复位或固定有问题，且没有坏死迹象，则应取下螺钉，复位在骨折处，应正确插入新鲜螺钉，并在骨折处应用植骨片（腓骨段或肌蒂植骨片）；以及（3）如果头部无血管，但关节未受影响，则可进行人工置换；如果关节老化或关节炎，则应进行全部置换。
对于老年患者，只应考虑两种方法：（1）如果疼痛相当严重，则最好移除股骨头，无论其是否为无血管性的，并且（如果患者合理地适合）进行全关节置换；（2）如果患者年老体弱，疼痛不可忍受，则应抬高脚跟和粗壮的棍子或者手肘拐杖通常就足够了。