骨科英文书籍精读（55）｜关节损伤（2）
RUPTURED LIGAMENT
The ligament is completely torn and the joint is unstable. Sometimes the ligament holds and the bone to which it is attached is avulsed; this is effectively the same lesion but easier to deal with because the bone
fragment can be securely reattached.
As with a strain, the joint is suddenly forced into an abnormal position; sometimes the patient actually hears a snap. The joints most likely to be affected are the ones that are insecure by virtue of their shape or
least well protected by surrounding muscles: the knee, ankle and finger joints.
Pain is severe and there may be considerable bleeding under the skin; if the joint is swollen, this is probably due to a haemarthrosis. The patient is unlikely to permit a searching examination, but under general anaesthesia the instability can be demonstrated; it is this that distinguishes the lesion from a strain. X-ray may show a detached flake of bone where the ligament is inserted.
Treatment
Torn ligaments heal by fibrous scarring. Previously this was thought inevitable and the surgeon’s task was to ensure that the torn ends were securely sutured so as to restore the ligament to its normal length. In some injuries, e.g. rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb, this approach is still valid. In others, however, it has changed; thus, solitary medial collateral ligament ruptures of the knee, even complete ruptures, are often treated non-operatively in the first instance. The joint is splinted and local measures are taken to reduce swelling. After 1–2 weeks, the splint is exchanged for a functional brace that allows joint movement but at the same time prevents repeat injury to the ligament, especially if some instability is also present. Physiotherapy is applied to maintain muscle strength and later proprioceptive exercises are added. This nonoperative approach has shown better results not only in the strength of the healed ligament but also in the nature of healing – there is less fibrosis (Woo et al., 2000). An exception to this non-operative approach is when the ligament is avulsed with an attached fragment of bone; reattachment of the fragment is indicated if the piece is large enough. Occasionally non-operative treatment may result in some residual instability that is clinically detectable; often this is not symptomatic, but if it is then surgical reconstruction should be considered.
---from 《Apley’s System of Orthopaedics and Fractures》P731
重点词汇整理：
avulsed adj. （伤口的组织等）被撕开的v. 撕脱；抽出（avulse的过去式）
reattach /rɪə'tætʃ/vt. （断肢）重新接上；再附着
snap /snæp/n. 猛咬；劈啪声；咯嗒一声;突然折断adj. 突然的
virtue /ˈvɜːrtʃuː/n. 美德；优点；贞操；功效
demonstrate/ˈdemənstreɪt/vt. 证明；展示；论证vi. 示威
fibrous scarring纤维疤痕
inevitable /ɪnˈevɪtəbl/adj. 必然的，不可避免的
suture /ˈsuːtʃər/n. 缝合；缝合处；缝合用的线vt. 缝合
ulnar collateral ligament尺侧副韧带
collateral /kəˈlætərəl/adj. 附属的；旁系的；并行的n. 抵押品，担保品；旁系亲属
metacarpophalangeal joint 掌指关节
valid /ˈvælɪd/adj. 有效的；有根据的；合法的；正当的
medial collateral ligament内侧副韧带
in the first instance首先；起初；在初审时
functional brace功能支具
proprioceptive /,prəupriəu'septiv/adj. 本体感受的
fibrosis/faɪ'brosɪs/n. [医] 纤维化，[病理] 纤维变性
residual /rɪˈzɪdʒuəl/adj. （数量）剩余的
detectable /dɪˈtektəbl/adj. 可检测的；可发觉的
symptomatic, /ˌsɪmptəˈmætɪk/adj. 有症状的；症候的
symptome /'simptəum/n. 症状
谷歌翻译：
韧带断裂
韧带完全撕裂，关节不稳定。有时韧带固定，其附着的骨头被撕脱；这实际上是相同的损伤，但更容易处理，因为骨头碎片可以安全地重新连接。
就像拉伤一样，关节突然被强迫到一个不正常的位置；有时病人真的会听到咔哒声。最有可能受到影响的关节是那些因其形状而不安全或受周围肌肉保护最差的关节：膝盖、脚踝和手指关节。
疼痛剧烈，皮下可能有大量出血；如果关节肿胀，可能是由于关节出血。病人不太可能允许进行搜索性检查，但在全身麻醉下可以表现出不稳定；正是这一点将病变与菌株区分开来。X光可能显示韧带插入的地方有一片脱落的骨片。
治疗
撕裂的韧带通过纤维疤痕愈合。以前，这被认为是不可避免的，外科医生的任务是确保撕裂的末端安全缝合，以便将韧带恢复到正常长度。在某些损伤中，例如拇指掌指关节尺侧副韧带断裂，这种方法仍然有效。然而，在其他情况下，情况已经改变；因此，膝关节的孤立内侧副韧带断裂，甚至完全断裂，通常首先要进行非手术治疗。关节用夹板固定，并采取局部措施减少肿胀。1-2周后，夹板会换成功能性支架，既能进行关节活动，又能防止韧带重复损伤，特别是在有些不稳定的情况下。理疗是用来维持肌肉力量的，后来又增加了本体感觉练习。这种非手术入路不仅在愈合韧带的强度方面显示出更好的效果，而且在愈合的本质上也显示出更好的效果--纤维化较少(Woo等人，2000年)。这种非手术入路的一个例外情况是韧带撕脱了附着骨的碎片；如果碎片足够大，则需要重新附着该碎片。偶尔非手术治疗可能会导致一些临床上可以检测到的残余不稳定；通常这是没有症状的，但如果是这样的话，应该考虑手术重建。