骨科英文书籍精读（311）｜膝关节韧带慢性损伤的临床表现（4）
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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Rotational stability can be tested in several ways:
Modified drawer test
The anterior drawer test is performed with the tibia in 30 degrees of internal rotation; if positive, it suggests anterolateral rotatory instability. Likewise, a positive drawer sign with the knee in external rotation (about 15 degrees) suggests anteromedial rotatory instability (Slocum and Larson, 1968).
Dial test
The leg is dangled over the edge of the couch. The examiner steadies the distal femur with one hand and holds the heel firmly in the other. The knee is flexed at 30 degrees. External rotation is applied through the heel and the position of the tibial tuberosity is noted. If external rotation is greater by 15 degrees as compared to the other side, a posterolateral corner injury is suspected. If the test is repeated with the knee flexed further to 90 degrees and the external rotation is noted to increase, a posterior cruciate injury is likely too (LaPrade and Wentorf, 2002).
Pivot shift test
The examiner supports the knee in extension with the tibia internally rotated (the subluxed position – the lateral tibial condyle is drawn in front of the femoral condyle); the knee is then gradually flexed while a valgus stress is applied. In a positive test, as the knee reaches 20 or 30 degrees, there is a sudden jerk as the tibial condyle slips backwards and reduces. The valgus stress compresses the lateral femoral condyle against the tibia and, through a jamming effect, amplifies the sudden ‘jerk’ when the condyle drops back. Another way to show this is MacIntosh’s test (Fig. 30.8). A positive pivot shift test indicates anterolateral rotatory instability. A modification of this test can be used to diagnose posterolateral rotatory instability; the tibia is held in external rotation while the knee is extended and, similarly, a valgus stress is applied as the knee is gradually flexed – a characteristic ‘clunk’ signals the change from a subluxed to a reduced position (the reverse pivot shift).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
Likewise /?la?kwa?z/adv. 同样地；也
dangle /ˈdæŋɡl/v. （使）摇晃地悬挂着；提着；炫示；用……来
jerk/dʒɜːrk/n. 急拉；猛的一动；肌肉抽搐；蠢人
jamming effect阻滞效应
jam /dʒæm/n. 果酱；拥挤；困境；扣篮vt. 使堵塞；挤进，使塞满；混杂；压碎
百度翻译：
旋转稳定性可以通过几种方式进行测试：
改良抽屉试验
前抽屉试验是在胫骨内旋转30度的情况下进行的；如果阳性，则表明前外侧旋转不稳定。同样，膝盖外旋（约15度）的抽屉征阳性提示前内侧旋转不稳定（Slocum和Larson，1968）。
拨号测试
腿悬在沙发边上。检查者用一只手固定股骨远端，另一只手紧紧握住脚跟。膝盖弯曲30度。通过脚跟进行外旋，注意胫骨粗隆的位置。如果外旋比另一侧大15度，则怀疑后外侧角受伤。如果在膝盖进一步弯曲至90度的情况下重复试验，并且注意到外旋增加，那么后十字韧带也可能受伤（LaPrade和Wentorf，2002）。
枢轴移位试验
检查者在胫骨内旋的情况下支撑膝盖伸展（半脱位位置-胫骨外侧髁在股骨髁前面牵引）；然后在施加外翻应力的同时，膝盖逐渐弯曲。在阳性测试中，当膝盖达到20度或30度时，胫骨髁向后滑动并减少，会出现突然的抽搐。外翻应力将股骨外侧髁压缩到胫骨上，并通过一种干扰效应，在髁状突后退时放大突然的“猛拉”。另一种方法是MacIntosh的测试（图30.8）。正轴移位试验表明前外侧旋转不稳定。此测试的改进可用于诊断后外侧旋转不稳定；当膝盖伸直时，胫骨保持外旋，同样，当膝盖逐渐弯曲时，施加外翻应力-特征性的“咯咯”信号表示从半脱位到减少位置的变化（反向枢轴移位）。