骨科英文书籍精读（226）｜髋关节前脱位
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ANTERIOR DISLOCATION
Anterior dislocation is rare compared with posterior. Dislocation of one or even both hips may occur when a weight falls onto the back of a miner or building labourer who is working with his legs wide apart, knees straight and back bent forwards. However, nowadays the usual cause is a road accident or air crash – even a posteriorly directed force on an abducted and externally rotated hip may cause the neck to impinge on the acetabular rim and lever the femoral head out in front of its socket. The femoral head will then lie superiorly (type I - pubic) or inferiorly (type II - obturator).
Clinical features
The leg lies externally rotated, abducted and slightly flexed. It is not short, because the attachment of rectus femoris prevents the head from displacing upwards. Occasionally the leg is abducted almost to a right angle. Seen from the side, the anterior bulge of the dislocated head is unmistakable, especially when the head has moved anteriorly and superiorly. The prominent head is easy to feel, either anteriorly (superior type) or in the groin (inferior type). Hip movements are impossible (Figure 29.3).
X-ray
In the anteroposterior view the dislocation is usually obvious, but occasionally the head is almost directly in front of its normal position; any doubt is resolved by a lateral film.
Treatment and complications
The manoeuvres employed are similar to those used to reduce a posterior dislocation, except that while the flexed knee is being pulled and the hip gently flexed upwards, it should be kept adducted; an assistant then helps by applying lateral pressure to the inside of the thigh. The point of reduction is usually heard and felt.The subsequent treatment is similar to that employed for posterior dislocation.
Avascular necrosis occurs in less than 10 per cent of cases.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
miner /ˈmaɪnər/n. 矿工；开矿机
an abducted and externally rotated hip外展、外旋的髋关节
impinge /ɪmˈpɪndʒ/v. 对……有明显作用（或影响）；妨碍；侵犯，侵占；撞击
then lie superiorly (type I - pubic) or inferiorly (type II - obturator).然后上卧(I型-耻骨)或下卧(II型-闭孔)。
rectus femoris股直肌
a right angle.直角
bulge/bʌldʒ/n. 胀；膨胀；凸出部分vt. 使膨胀；使凸起vi. 膨胀；凸出
unmistakable/ˌʌnmɪˈsteɪkəbl/adj. 明显的；不会弄错的
groin /ɡrɔɪn/n. [解剖] 腹股沟；交叉拱vt. 使成穹棱
manoeuvres /məˈnuːvər/n. 特技动作，熟练动作；（尤指以欺骗为目的）策略，手段；欺诈性操作；军事演习（等于 maneuver）v. （使谨慎或熟练地）移动；操控，使花招；诱使，诱导
gently flexed upwards轻轻向上弯曲
/ˈdʒentli/adv. 轻轻地；温柔地，温和地
adduct 使内收
abduct 使外展
百度翻译：
前脱位
前脱位较后脱位少见。当重物落在矿工或建筑工人的背上时，可能会出现一个或两个臀部脱位，工人的双腿分开，膝盖伸直，背部向前弯曲。然而，现在常见的原因是交通事故或空难——即使是对外展髋关节和外旋髋关节施加的后向力，也可能导致颈部撞击ac 髋臼边缘，并将股骨头从其窝前方撬出。股骨头将位于上方（I型耻骨）或下方（II型-闭孔器）。
临床特征
腿外旋，外展，轻微弯曲。它并不短，因为股骨头的附着阻止了头部向上移位。有时腿几乎被拐弯成直角。从侧面看，脱臼的头部的前凸出是明确无误的，特别是当头部向前和上方移动时。突出的头部很容易感觉到，无论是在前面（上侧型）还是在腹股沟（下侧型）。臀部运动是不可能的（图29.3）。
X射线
在正位影像中，脱位通常很明显，但偶尔头部几乎直接位于正常位置的正前方；任何疑问都可以通过侧位片来解决。
治疗及并发症
所采用的手法与用于减少后脱位的手法相似，只是当弯曲的膝盖被拉住，臀部轻轻向上弯曲时，应该保持内收；然后助手通过向大腿内侧施加侧向压力来帮助。还原点通常被听到并且感觉到了后续治疗方法与后路脱位相似。
缺血性坏死发生率不到10%。