骨科英文书籍精读（330）｜髌骨骨折（3）
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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Treatment
Undisplaced or minimally displaced fractures
If there is a haemarthrosis it should be aspirated. The extensor mechanism is intact and treatment is mainly protective. A plaster cylinder holding the knee straight should be worn for 3–4 weeks, and during this time quadriceps exercises are to be practised every day.
Comminuted (stellate) fracture
The extensor expansions are intact and the patient may be able to lift the leg.
However, the undersurface of the patella is irregular and there is a serious risk of damage to the patellofemoral joint. For this reason some people advocate patellectomy, whatever the degree of displacement. To others it seems reasonable to preserve the patella if the fragments are not severely displaced (or to remove only those fragments that obviously distort the articular surface); a hinged brace is used in extension but unlocked several times daily for exercises to mould the fragments into position and to maintain mobility.
Displaced transverse fracture
The lateral expansions are torn and the entire extensor mechanism is disrupted. Operation is essential.
Through a longitudinal incision the fracture is exposed and the patella repaired by the tension-band principle. The fragments are reduced and transfixed with two stiff K-wires; flexible wire is then looped tightly around the protruding K-wires and over the front of the patella (Fig. 30.15). The tears in the extensor expansions are then repaired. A plaster backslab or hinged brace is worn until active extension of the knee is regained; either may be removed every day to permit active knee-flexion exercises.
Outcome
Patients usually regain good function but, depending on the severity of the injury, there is a significant incidence of late patellofemoral osteoarthritis.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
quadriceps exercises 股四头肌（等长收缩）训练
longitudinal incision纵切口
the tension-band principle张力带原则
flexible wire软线
flexible /ˈfleksəbl/adj. 灵活的；柔韧的；易弯曲的
there is a significant incidence of late patellofemoral osteoarthritis.晚期髌股骨关节炎的发生率很高。
incidence/ˈɪnsɪdəns/n. 发生率；影响
百度翻译（仅供参考，建议自己翻译）：
治疗
未移位或移位最小的骨折
如果有血栓性关节炎，应该进行抽吸。伸肌机制完整，治疗以保护为主。保持膝盖伸直的石膏筒应佩戴3-4周，在此期间，每天都要练习股四头肌。
粉碎性（星状）骨折
伸肌扩张完整，患者可以抬起腿。
然而，髌骨的下表面是不规则的，髌股关节有严重损伤的危险。出于这个原因，有些人主张髌骨切除术，无论移位的程度如何。对于其他人来说，如果髌骨碎片没有严重移位（或者只移除那些明显扭曲关节面的碎片），则保留髌骨似乎是合理的；铰链支架用于伸展，但每天数次解锁，以便将碎片固定到位并保持活动性。
移位横断
外侧扩张被撕裂，整个伸肌机制被破坏。操作是必不可少的。
通过纵向切口暴露骨折，利用张力带原理修复髌骨。碎片被缩小并用两根硬的K形钢丝穿过；然后软钢丝紧紧地缠绕在突出的K形钢丝上，并覆盖在髌骨前部（图30.15）。然后修复伸肌扩张处的撕裂。在恢复膝盖的主动伸展之前，应佩戴石膏背板或铰链支撑；可每天移除其中任何一个，以便进行主动屈膝练习。
结果
患者通常恢复良好的功能，但根据损伤的严重程度，晚期髌股骨关节炎的发生率很高。