骨科英文书籍精读（224）｜髋关节后脱位晚期并发症（1）
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Avascular necrosis
Avascular necrosis of the femoral head has been reported in about 10 per cent of traumatic hip dislocations; if reduction is delayed by more
than 12 hours, the figure rises to over 40 per cent.
Changes are seen first on MRI or isotope bone scans. X-ray features such as increased density of the femoral head may not be seen for at least 6 weeks, and sometimes very much later (up to 2 years), depending on the rate of bone repair.
Ischaemia is due to interruption of femoral head blood supply when the hip is dislocated. There is evidence to suggest that this results from compression, traction and arterial spasm rather than actual disruption of blood vessels (Shim 1979), which means that the consequences of ischaemia are proportional to the delay in starting treatment; blood flow is restored on reduction of the hip, especially if this is performed early – which highlights the need for emergency treatment with a target of less than 12 hours (preferably less than 6) from the time of injury.
If the femoral head develops signs of fragmentation, an operation may be needed. If the necrotic segment is small, realignment osteotomy is the method of choice; for extensive femoral head collapse, usually with accompanying degenerative arthritis, the choice is between joint replacement and hip arthrodesis (never an easy procedure).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
isotope /ˈaɪsətoʊp/n. 同位素
isotope bone scans.同位素骨扫描。
Ischaemia /is'ki:miə/n. 局部贫血
spasm /ˈspæzəm/n. [临床] 痉挛；抽搐；一阵发作
actual disruption of blood vessels真正的血管破裂
which means that the consequences of ischaemia are proportional to the delay in starting treatment; 这意味着缺血的后果与开始治疗的延迟成正比;
proportional /prəˈpɔːrʃənl/n. [数] 比例项adj. 比例的，成比例的；相称的，均衡的
restore/rɪˈstɔːr/vi. 恢复；还原vt. 恢复；修复；归还
fragmentation /ˌfræɡmenˈteɪʃn/n. 破碎；分裂；[计] 存储残片
realignment osteotomy调整截骨术
degenerative arthritis,退行性关节炎
degenerative /dɪˈdʒenərətɪv/adj. （疾病）恶化的，变性的；退化的，变坏的
arthrodesis /ɑ:'θrɔdəsis/n. [外科] 关节固定术;关节融合术
百度翻译：
晚期并发症
缺血性坏死
据报道，约10%的创伤性髋关节脱位发生股骨头缺血性坏死；如果复位延迟更多
超过12小时，这一数字上升到40%以上。
变化首先在核磁共振或同位素骨扫描上看到。根据骨修复率的不同，股骨头密度增加等X线表现至少在6周内不可见，有些甚至很晚（最多2年）见不到。
缺血是由于髋关节脱位时股骨头供血中断引起的。有证据表明，这是由压迫、牵引和动脉痉挛引起的，而不是血管的实际损伤（Shim 1979），这意味着缺血的后果与开始治疗的延迟成正比；髋关节复位后血流恢复，尤其是在早期进行的情况下，这突出了急救的必要性，目标是从受伤时间起少于12小时（最好少于6小时）。
如果股骨头出现碎裂迹象，可能需要手术。如果坏死段很小，可以选择重新定线截骨术；对于广泛的股骨头塌陷，通常伴有退行性关节炎，可在关节置换和髋关节融合术之间进行选择（从来不是一个简单的程序）。