骨科英文书籍精读（231）｜股骨颈骨折分型（2）
中国十大名师之一赖世雄老师说过，学习英语没有捷径，少就是多，快就是慢。不要以量取胜，把一个音标、一个单词、一段对话、一篇文章彻底搞透，慢慢积累，你会发现，你并不比每天走马观花的输入大量英文学的差。
Healing of femoral neck fractures is bedevilled by two problems: the threat of bone ischaemia and tardy union. The femoral head gets its blood supply from three sources: (1) intramedullary vessels in the femoral neck; (2) ascending cervical branches of the medial and lateral circumflex anastomoses, which run within the capsular retinaculum before entering the bone at the articular margin of the femoral head; and (3) the vessels of the ligamentum teres. The intramedullary supply is always interrupted by the fracture; the retinacular vessels, also, may be kinked or torn if the fracture is displaced. In elderly people, the remaining supply in the ligamentum teres is at best fairly meagre and, in 20 per cent of cases, nonexistent. Hence the high incidence of avascular necrosis in displaced femoral neck fractures.
Transcervical fractures are, by definition, intracapsular. They have a poor capacity for healing because: (1) by tearing the retinacular vessels the injury deprives the head of its main blood supply; (2) intra-articular
bone has only a flimsy periosteum and no contact with soft tissues which could promote callus formation; and (3) synovial fluid prevents clotting of the fracture haematoma. Accurate apposition and impaction of bone fragments are therefore of more importance than usual. There is evidence that aspirating a haemarthrosis increases the blood flow in the femoral head by relieving tension in the capsule, and the practice is encouraged at the time of surgery (Harper, Barnes et al. 1991; Bonnaire and Weber 2002).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
bedevilled美 /bɪˈdevld/折磨；使迷惑（bedevil的过去式和过去分词）
/bɪˈdevl/vt. 使痛苦；虐待；使苦恼
tardy /ˈtɑːrdi/n. 迟到adj. 缓慢的，迟缓的；迟到的
intramedullary/,intrə,me'dʌləri/adj. [解剖] 髓内的
cervical /ˈsɜːrvɪkl/adj. 颈的；子宫颈的
anastomoses /,ænəstə'məusi:z/n. （血管筋脉等的）吻合；愈合
margin /ˈmɑːrdʒɪn/n. 边缘；利润，余裕；页边的空白vt. 加边于；加旁注于
meagre /ˈmiːɡər/adj. 瘦的；贫弱的；贫乏的
intracapsular.囊内的；
intra-articular关节内的
flimsy /ˈflɪmzin. 薄纸；复写纸；打字纸adj. 脆弱的；浅薄的；易损坏的；不周密的
periosteum /,perɪ'ɑstɪəm/n. [解剖] 骨膜；管膜
callus /ˈkæləs/骨痂
synovial fluid 滑液 ；关节液
/si'nəuviəl, sai-/adj. 滑液的；分泌滑液的
There is evidence that aspirating a haemarthrosis increases the blood flow in the femoral head by relieving tension in the capsule。有证据表明，吸出关节内积血可通过缓解股骨头囊内的压力而增加股骨头内的血流量。
There is evidence that ...有证据表明...
百度翻译：
股骨颈骨折的愈合受到两个问题的困扰：骨缺血的威胁和延迟愈合。股骨头的血液供应来自三个来源：（1）股骨颈的髓内血管；（2）旋前内侧和外侧吻合术的颈升支，在进入股骨头关节边缘的骨之前在囊支持带内运行；（3）圆韧带的血管。髓内供应总是因骨折而中断；如果骨折移位，支持带血管也可能扭结或撕裂。在老年人中，圆韧带的剩余供应充其量是相当少的，在20%的情况下是不存在的。因此，移位股骨颈骨折中缺血性坏死的发生率很高。
根据定义，经颈骨折是椎体内骨折。他们的愈合能力很差，因为：（1）通过撕裂支持带血管，损伤剥夺了头部的主要血液供应；（2）关节内
骨只有一层薄薄的骨膜，与软组织无接触，可促进骨痂的形成；（3）滑膜液可防止骨折血肿凝固。因此，骨碎片的精确定位和嵌塞比通常更为重要。有证据表明，吸血可以通过缓解胶囊内的张力来增加股骨头的血流量，手术时鼓励这样做（Harper，Barnes等人，1991；Bonnaire和Weber，2002）。