骨科英文书籍精读（264）｜儿童股骨干骨折保守治疗
我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
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THE ISOLATED FEMORAL SHAFT FRACTURE
Traction, bracing and spica casts
Traction can reduce and hold most fractures in reasonable alignment, except those in the upper third of the femur. Joint mobility can be ensured by active exercises. The chief drawback is the length of time spent in bed (10–14 weeks for adults) with the attendant problems of keeping the femur aligned until sufficient callus has formed plus reducing patient morbidity and frustration. Some of these difficulties are overcome by changing to a plaster spica or – in the case of lower third fractures – functional bracing when the fracture is ‘sticky’, usually around 6–8 weeks.
The main indications for traction are (1) fractures in children; (2) contraindications to anaesthesia; and (3) lack of suitable skill or facilities for internal fixation. It is a poor choice for elderly patients, for pathological fractures and for those with multiple injuries.
The various methods of traction are described in Chapter 23. For young children, skin traction without a splint is usually all that is needed. Infants less than 12 kg in weight are most easily managed by suspending the lower limbs from overhead pulleys (‘gallows traction’), but no more than 2 kg weight should be used and the feet must be checked frequently for circulatory problems. Older children are better suited to Russell’s traction (Chapter 23见下图) or use of a Thomas’ splint. Fracture union will have progressed sufficiently by 2–4 weeks (depending on the age of the child) to permit a hip spica to be applied and the child is then allowed up. Consolidation is usually complete by 6–12 weeks.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
active exercises主动运动
The chief drawback is the length of time spent in bed (10–14 weeks for adults) with the attendant problems of keeping the femur aligned until sufficient callus has formed plus reducing patient morbidity and frustration.
(骨牵引治疗)主要的缺点是卧床时间长(成人10-14周)，随之而来的问题是保持股骨对齐直到形成足够的骨痂，以及减少患者的发病率和挫感。
drawback /ˈdrɔːbæk/n. 缺点，不利条件；退税
attendant /əˈtendənt/adj. 伴随的；陪伴的n. 服务员，侍者；随员，陪从；参与者
functional bracing功能支具
/ˈbreɪsɪŋ/n. 支撑，支柱；背带adj. 令人振奋的，凉爽的；支撑的
contraindication /ˌkɑːntrəˌɪndɪˈkeɪʃn/n. [医] 禁忌症；禁忌征候
contraindications to anaesthesia麻醉禁忌
pulley /ˈpʊli/n. 滑轮；皮带轮；滑车
Consolidation /kənˌsɑːlɪˈdeɪʃn/
n. 巩固；合并；团结
Consolidation is usually complete by 6–12 weeks.
巩固通常在6-12周完成。
百度翻译：
孤立性股骨干骨折
牵引力、支撑力和spica石膏
牵引可以减少和保持大多数骨折在合理的路线，除了那些在上三分之一的股骨。关节活动可以通过积极的锻炼来保证。主要缺点是卧床时间长（成人为10-14周），随之而来的问题是保持股骨对齐，直到形成足够的骨痂，并减少患者发病率和骨折。其中一些困难可以通过更换石膏钉来克服，或者在下三分之一骨折的情况下，在骨折“粘滞”时使用功能性支撑，通常在6-8周左右。
牵引的主要适应证有：（1）儿童骨折；（2）麻醉禁忌症；（3）缺乏合适的内固定技术或设施。对于老年患者、病理性骨折和多发伤患者来说，这是一个糟糕的选择。
第23章介绍了各种牵引方法。对于幼儿来说，不使用夹板的皮肤牵引通常是唯一需要的。体重小于12公斤的婴儿最容易通过将下肢悬挂在高架滑轮上（“绞架牵引”）来控制，但体重不应超过2公斤，并且必须经常检查脚部是否有循环问题。年龄较大的孩子更适合拉塞尔牵引法（第23章）或托马斯夹板的使用。骨折愈合将充分进展2-4周（取决于孩子的年龄），以便进行髋关节置换，然后让孩子起床。巩固通常在6-12周内完成。