骨科英文书籍精读（356）｜胫腓骨骨折术后畸形愈合
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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Late complications
Malunion
Slight shortening (up to 1.5 cm) is usually of little consequence, but rotation and angulation deformity, apart from being unsightly, can be disabling because the knee and ankle no longer move in the same plane.
Angulation should be prevented at all stages; anything more than 7 degrees in either plane is unacceptable. Angulation in the sagittal plane, especially if accompanied by a stiff equinus ankle, produces a marked increase in sheer forces at the fracture site during walking; this may result in either refracture or non-union.
Varus or valgus angulation will alter the axis of loading through the knee or ankle, causing increased stress in some part of the joint. This is often cited as a cause of secondary osteoarthritis; however while this may be true for angular deformities close to the joint, long-term studies have failed to show that it applies to moderate deformities in the middle third of the bone.
Rotational alignment should be near-perfect (as compared with the opposite leg). This may be difficult to achieve with closed methods, but it should be possible with locked intramedullary nailing.
Late deformity, if marked, should be corrected by tibial osteotomy.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
sagittal plane矢状平面
equinus马蹄足（一种发育性畸形）
Late deformity, if marked, should be corrected by tibial osteotomy.晚期畸形，如果明显，应通过胫骨截骨术矫正。
有道翻译（仅供参考，建议自己翻译）：
晚期并发症
畸形愈合
轻微缩短（高达1.5厘米）通常影响不大，但旋转和成角畸形除了难看外，还可能致残，因为膝盖和脚踝不再在同一平面内移动。
在所有阶段都应防止成角；任何超过7度的物体都是不可接受的。矢状面成角，尤其是伴有马蹄关节僵硬的情况下，行走时骨折处的剪切力明显增加；这可能导致再骨折或不愈合。
内翻或外翻角度会改变通过膝盖或脚踝的负荷轴，导致关节某些部位的应力增加。这经常被认为是继发性骨关节炎的原因；然而，尽管这可能适用于关节附近的角形畸形，但长期研究未能表明它适用于中三分之一骨骼的中度畸形。
旋转对齐应接近完美（与对侧腿相比）。这可能很难用闭合的方法实现，但用带锁髓内钉应该是可行的。
晚期畸形如有明显改变，应行胫骨截骨矫治。