骨科英文书籍精读（259）｜股骨干骨折病理解剖
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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Pathological anatomy
Most fractures of the femoral shaft have some degree of comminution, although it is not always apparent on x-ray. Small bone fragments, or a single large ‘butter-fly’ fragment, may separate at the fracture line but usually remain attached to the adjacent soft tissue and retain their blood supply. With more extensive comminution there is no point of firm contact between proximal and distal fragments and the fracture is completely unstable (Figure 29.20). This is the basis of a helpful classification (Winquist, Hansen et al. 1984).
Fracture displacement often follows a predictable pattern dictated by the pull of muscles attached to each fragment.
· In proximal shaft fractures the proximal fragment is flexed, abducted and externally rotated because of gluteus medius and iliopsoas pull; the distal fragment is frequently adducted.
· In mid-shaft fractures the proximal fragment is again flexed and externally rotated but abduction is less marked.
· In lower third fractures the proximal fragment is adducted and the distal fragment is tilted by gastrocnemius pull.
The soft tissues are always injured and bleeding from the perforators of the profunda femoris may be severe. Over one litre may be lost into the tissues and,in the case of bilateral femoral shaft fractures, the patient can become hypotensive quickly if not adequately resuscitated. Beware of the fracture at the junction of the middle and distal thirds of the femoral shaft – it can be responsible for damaging the femoral artery in the adductor canal.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
‘butter-fly’ fragment蝶形骨块
Fracture displacement often follows a predictable pattern dictated by the pull of muscles attached to each fragment.骨折移位通常遵循一个可预测的模式，该模式由附着在每个碎片上的肌肉的拉力决定。
lower third fractures下三分之一骨折
gastrocnemius /ˌɡæstrɑːkˈniːmiəs/腓肠肌
litre /ˈliːtər/n. [计量] 公升（米制容量单位）
hypotensive /,haipəu'tensiv/n. 低血压患者adj. 降低血压的；患低血压的
hypertensive/,haipə'tensiv/adj. 高血压的；血压升高的n. 高血压患者；使血压升高的药物
resuscitate /rɪˈsʌsɪteɪt/vt. 使复苏；使复兴vi. 恢复；复兴
the adductor canal（内）收肌管
百度翻译：
病理解剖
大多数股骨干骨折都有一定程度的粉碎，尽管在x光片上并不总是很明显。小的骨碎片，或单个大的“黄油蝇”碎片，可能在骨折线上分离，但通常仍附着在邻近的软组织上，并保留其血液供应。在更广泛的解剖中，近端和远端碎片之间没有牢固的接触点，骨折完全不稳定（图29.20）。这是有用分类的基础（Winquist、Hansen等人，1984年）。
骨折移位通常遵循一种可预测的模式，由附着在每个骨折块上的肌肉的拉力决定。
·在近端骨干骨折中，由于臀中肌和髂腰肌的牵引，近端骨折块弯曲、外展和外旋；远端骨折块经常内收。
·在中轴骨折中，近端骨折块再次弯曲和外旋，但外展不明显。
·在下三分之一骨折中，近端骨折块内收，远端骨折块在腓肠肌牵引下倾斜。
软组织常受损伤，股深部穿支出血严重。超过一公升的血液可能会流失到组织中，在双侧股骨干骨折的情况下，如果不能充分复苏，患者可能会迅速出现低血压。当心股骨干中段和远端三分之一交界处的骨折——它可能是损伤内收肌管内股动脉的罪魁祸首。