骨科英文书籍精读（6）｜骨不连
UNION, CONSOLIDATION AND NON-UNION
Repair of a fracture is a continuous process: any stages into which it is divided are necessarily arbitrary. In this book the terms ‘union’ and ‘consolidation’ are used, 690 and they are defined as follows:
· Union – Union is incomplete repair; the ensheathing callus is calcified. Clinically the fracture site is still a little tender and, though the bone moves in one piece (and in that sense is united), attempted angulation is painful. X-Rays show the fracture line still clearly visible, with fluffy callus around it. Repair is incomplete and it is not safe to subject the unprotected bone to stress.
· Consolidation – Consolidation is complete repair; the calcified callus is ossified. Clinically the fracture site is not tender, no movement can be obtained and attempted angulation is painless. X-rays show the fracture line to be almost obliterated and crossed by bone trabeculae, with well-defined callus around it. Repair is complete and further protection is unnecessary.
· Timetable – How long does a fracture take to unite and to consolidate? No precise answer is possible because age, constitution, blood supply, type of fracture and other factors all influence the time taken.
Approximate prediction is possible and Perkins’ timetable is delightfully simple. A spiral fracture in the upper limb unites in 3 weeks; for consolidation multiply by 2; for the lower limb multiply by 2 again; for transverse fractures multiply again by 2. A more sophisticated formula is as follows. A spiral fracture in the upper limb takes 6–8 weeks to consolidate; the lower limb needs twice as long. Add 25% if the fracture is not spiral or if it involves the femur. Children’s fractures, of course, join more quickly. These figures are only a rough guide; there must be clinical and radiological evidence of consolidation before full stress is permitted without splintage.
· Non-union – Sometimes the normal process of fracture repair is thwarted and the bone fails to unite. Causes of non-union are: (1) distraction and separation of the fragments, sometimes the result of interposition of soft tissues between the fragments; (2) excessive movement at the fracture line; (3) a severe injury that renders the local tissues nonviable or nearly so; (4) a poor local blood supply and (5) infection. Of course surgical intervention, if ill-judged, is another cause!
Non-unions are septic or aseptic. In the latter group, they can be either stiff or mobile as judged by clinical examination. The mobile ones can be as free and painless as to give the impression of a false joint (pseudoarthrosis). On x-ray, non-unions are typified by a lucent line still present between the bone fragments; sometimes there is exuberant callus trying – but failing – to bridge the gap (hypertrophic non-union) or at times none at all (atrophic non-union) with a sorry, withered appearance to the fracture ends.
---from 《Apley’s System of Orthopaedics and Fractures》P91
重点词汇整理：
arbitrary 任意的；武断的；专制的
the ensheathing callus is calcified覆盖层的骨痂钙化
fluffy /ˈflʌfi/adj. 蓬松的；松软的；毛茸茸的
it is not safe to subject the unprotected bone to stress使未受保护的骨头受到压力是不安全的
calcified callus
钙化的骨痂
calcify /ˈkælsɪfaɪ/vt. 使钙化；使思想僵化
X-rays show the fracture line to be almost obliterated and crossed by bone trabeculaex 线显示骨折线几乎消失，并有骨小梁穿过
obliterated /ə'blitəreitid/
v. 摧毁；抹除
trabeculae /trə'bɛkjələ/n. 骨小梁
constitution /ˌkɑːnstɪˈtuːʃn/n. 宪法；体制；组成；体格
A more sophisticated formula is as follows。下面是一个更复杂的公式
These figures are only a rough guide这些数字只是一个粗略的参考
radiological /redɪo'lɑdʒɪkəl/adj. 放射学的
thwarted v. 挫败（thwart的过去分词）；反对adj. 挫败的
thwart /θwɔːrt/prep. 横过n. 划手座；独木舟的横梁vt. 挫败；反对；阻碍；横过
a severe injury that renders the local tissues nonviable or nearly so;使局部组织丧失活力或几乎丧失活力的严重损伤;
nonviable/nɑn'vaɪəbl/adj. 不能存活的
ill-judged/ˌɪl ˈdʒʌdʒd/adj. 欠思考的；判断失当的
Non-unions are septic or aseptic.骨不连是感染性的或无菌的。
septic/ˈseptɪk/n. 腐烂物adj. 败血症的；[医] 脓毒性的；腐败的
aseptic/ˌeɪˈseptɪk/n. [助剂] 防腐剂adj. 无菌的；防腐性的
stiff or mobile僵硬或移动 /stɪf/adj. 呆板的；坚硬的
pseudoarthrosis 假关节
pseud /suːd/n. 假知识分子；伪善者；虚伪的人adj. 假的；虚伪的；不诚实的
lucent /'lʊsnt/adj. 透明的，光亮的；
exuberant callus 旺盛的骨痂
exuberant /ɪɡˈzuːbərənt/adj. 精力充沛的，热情洋溢的；兴高采烈的；繁茂的，茂盛的；充满生气的，鲜艳的；充满活力和想象力的
hypertrophic non-union 肥大型骨不连
atrophic non-union 萎缩型骨不连
withered/ˈwɪðərd/v. 干枯；减弱；羞愧（wither的过去分词）
百度翻译：
愈合、坚强愈合、骨不连
骨折的修复是一个连续的过程：骨折的任何阶段都必然是任意的。在本书中，使用术语“联合”和“合并”，690，其定义如下：
·结合-结合不完全修复；包涵骨痂钙化。临床上，骨折部位仍然有点软，尽管骨头是一块一块地移动（从这个意义上说是统一的），但尝试成角是痛苦的。X光片显示骨折线仍然清晰可见，周围有蓬松的老茧。修复是不完整的，使未受保护的骨骼承受压力是不安全的。
·巩固-巩固是完全修复；钙化骨痂是骨化。临床上骨折部位不痛，不能活动，无疼痛感。X光片显示骨折线几乎被抹去，并与骨小梁交叉，周围有清晰的骨痂。维修完成，无需进一步保护。
·时间表-骨折愈合需要多长时间？由于年龄、体质、血液供应、骨折类型和其他因素都会影响所花费的时间，所以没有确切的答案。
大致的预测是可能的，珀金斯的时间表非常简单。上肢的螺旋状骨折在3周内愈合；如果是合并骨折，则乘以2；如果是下肢骨折，则乘以2
再次；对于横向骨折再次乘以2。一个更复杂的公式如下。上肢螺旋形骨折需要6-8周的时间来巩固；下肢需要两倍的时间。如果骨折不是螺旋形或涉及股骨，则增加25%。儿童骨折，当然，加入得更快。这些数字只是一个粗略的指南；在没有夹板的情况下允许完全应力之前，必须有临床和放射学上的巩固证据。
·不愈合-有时骨折修复的正常过程受阻，骨无法愈合。不愈合的原因是：（1）碎片分散和分离，有时是软组织在碎片之间插入的结果；（2）骨折线过度移动；（3）严重损伤，使局部组织无法活动或接近活动；（4）局部血供不足和（5）感染。当然，手术干预，如果判断不当，是另一个原因！
非结合性感染或无菌。在后一组中，根据临床检查，他们可以是僵硬的或活动的。可移动的关节可以像假性关节炎一样自由无痛。在x光片上，骨不连的典型表现是骨碎片之间仍然存在一条亮光线；有时有大量的骨痂试图（但未能）弥合间隙（肥大性不连），或者有时根本没有（萎缩性不连），骨折端出现一个令人遗憾的、枯萎的外观。