骨科英文书籍精读（14）｜切开复位及固定
OPEN REDUCTION
Operative reduction of the fracture under direct vision is indicated: (1) when closed reduction fails, either because of difficulty in controlling the fragments or because soft tissues are interposed between them; (2) when there is a large articular fragment that needs accurate positioning or (3) for traction (avulsion) fractures in which the fragments are held apart. As a rule, however, open reduction is merely the first step to internal fixation.
HOLD REDUCTION
The word ‘immobilization’ has been deliberately avoided because the objective is seldom complete immobility; usually it is the prevention of displacement. Nevertheless, some restriction of movement is needed to promote soft-tissue healing and to allow free movement of the unaffected parts. The available methods of holding reduction are:
· Continuous traction.
· Cast splintage.
· Functional bracing.
· Internal fixation.
· External fixation.
In the modern technological age, ‘closed’ methods are often scorned – an attitude arising from ignorance rather than experience. The muscles surrounding a fracture, if they are intact, act as a fluid compartment; traction or compression creates a hydraulic effect that is capable of splinting the fracture. Therefore closed methods are most suitable for fractures with intact soft tissues, and are liable to fail if they are used as the primary method of treatment for fractures with severe soft-tissue damage. Other contraindications to nonoperative methods are inherently unstable fractures, multiple fractures and fractures in confused or uncooperative patients. If these constraints are borne in mind, closed reduction can be sensibly considered in choosing the most suitable method of fracture splintage. Remember, too, that the objective is to splint the fracture, not the entire limb!
---from 《Apley’s System of Orthopaedics and Fractures》P696-697
重点词汇整理：
under direct vision直视下 /dərekt,daɪˈrekt/
traction (avulsion) fractures 牵引(撕脱)骨折
immobilization /ɪˌmoʊbələˈzeɪʃn/n. 使停止流通，固定
deliberately /dɪˈlɪbərətli/adv. 故意地；谨慎地；慎重地
immobility /ˌɪməˈbɪləti/n. 不动，固定
Nevertheless, some restriction of movement is needed to promote soft-tissue healing and to allow free movement of the unaffected parts. 然而，为了促进软组织愈合和使未受影响的部分自由活动，需要对活动进行一些限制。
Functional bracing.功能支撑。
/ˈbreɪsɪŋ/adj. 令人振奋的，凉爽的；支撑的n. 支撑，支柱；背带
scorn/skɔːrn/n. 轻蔑；嘲笑；藐视的对象v. 轻蔑；藐视；不屑做
ignorance/ˈɪɡnərəns/n. 无知，愚昧；不知，不懂
hydraulic /haɪˈdrɔːlɪk/adj. 液压的；水力的；水力学的
be liable to 易于... ...
liable/ˈlaɪəbl/adj. 有责任的，有义务的；应受罚的；有…倾向的；易…的
severe soft tissue damage 严重的软组织损伤
contraindications 禁忌症（contraindication的复数）
nonoperative 非手术的
inherently /ɪnˈherəntli,ɪnˈhɪrəntli/adv. 内在地；固有地；天性地
multiple fractures多发骨折
are borne in mind, 被记住
borne/bɔːrn/v. 忍受；负荷；结果实；生子女（bear的过去分词）
百度翻译：
切开复位
直视下骨折的手术复位是指：（1）当闭合复位失败时，要么是由于控制骨折碎片困难，要么是由于软组织夹在骨折碎片之间；（2） 当有大的关节碎片需要精确定位或（3）牵引（撕脱）骨折时，碎片被分开。一般来说，切开复位仅仅是内固定的第一步。
复位后固定
“固定”这个词是故意避免的，因为目标很少是完全固定的；通常是防止移位。然而，为了促进软组织愈合和允许未受影响的部分自由移动，需要对运动进行一些限制。复位后固定的可用方法有：
·持续牵引。
·石膏夹板。
·功能支撑。
·内固定。
·外固定。
在现代科技时代，“闭合复位”的方法常常被人鄙视——这种态度是由无知而非经验引起的。骨折周围的肌肉，如果完好的话，可以充当一个流体室；牵引或压缩产生一种液压效应，可以夹住骨折。因此，闭合法最适合于软组织完整的骨折，如果将其作为治疗严重软组织损伤骨折的主要方法，则容易失败。非手术方法的其他禁忌症包括先天性不稳定骨折、多发性骨折以及困惑或非手术患者的骨折。如果这些约束是在
注意，在选择最合适的骨折夹板方法时，可以考虑闭合复位。也要记住，目的是用夹板夹住骨折，而不是整个肢体！