骨科英文书籍精读（270）｜股骨干骨折合并血管损伤
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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FRACTURES ASSOCIATED WITH VASCULAR INJURY
Warning signs of an associated vascular injury are (1) excessive bleeding or haematoma formation; and (2) paraesthesia, pallor or pulselessness in the leg and foot. Do not accept ‘arterial spasm’ as a cause of absent pulses; the fracture level on x-ray will indicate the region of arterial damage and arteriography may only delay surgery to re-establish perfusion. Most femoral fractures with vascular injuries will have had warm ischaemia times greater than 2–3 hours by the time the patient arrives in the operating theatre; when this exceeds 4–6 hours, salvage may not be possible and the risk of amputation rises. This means that diagnosis must be prompt and re-establishing perfusion a priority; fracture stabilization is secondary.
A recommended sequence for treatment, particularly if the warm ischaemia time is approaching the salvage threshold, is (a) to create a shunt from the femoral vessels in the groin to beyond the point of injury using plastic catheters; (b) to stabilize the fracture (usually by plating or external fixation) and then (c) to carry out definitive vascular repair. This sequence establishes blood flow quickly and permits fracture fixation and vascular repair to be carried out without pressure of time.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
Most femoral fractures with vascular injuries will have had warm ischaemia times greater than 2–3 hours by the time the patient arrives in the operating theatre.大多数血管损伤的股骨骨折在患者到达手术室时，会有2-3小时以上的热缺血。
salvage/ˈsælvɪdʒ/n. 打捞；海上救助；抢救财货；救难的奖金vt. 抢救；海上救助
the salvage threshold抢救期限
threshold /ˈθreʃhoʊld/n. 入口；门槛；开始；极限；临界值
shunt /ʃʌnt/调轨，转轨；分流管；吻合分流术
This sequence establishes blood flow quickly and permits fracture fixation and vascular repair to be carried out without pressure of time.这一抢救流程可以快速建立血流，使得骨折固定和血管修复可以在没有时间压力的情况下进行。
百度翻译：
骨折伴血管损伤
相关血管损伤的警告标志是：（1）出血过多或血肿形成；（2）腿部和足部感觉异常、苍白或无脉搏。不要将“动脉痉挛”视为脉搏缺失的原因；x光片上的骨折程度将指示动脉损伤区域，动脉造影可能只会延迟手术以重建灌注。大多数伴有血管损伤的股骨骨折患者到达手术室时，热缺血时间超过2-3小时；当超过4-6小时时，抢救可能无法进行，截肢风险增加。这意味着诊断必须及时，重建灌注是首要的；骨折稳定是次要的。
一个推荐的治疗顺序，特别是如果热缺血时间接近挽救阈值，是（A）使用塑料导管从腹股沟的股动脉分流到损伤点以外；（b） 稳定骨折（通常通过钢板或外固定）然后（c）进行明确的血管修复。这个序列建立了快速的血流，使得骨折固定和血管修复可以在没有时间压力的情况下进行。