骨科英文书籍精读（238）｜股骨颈骨折的治疗(4)
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。
Prosthetic replacement
This procedure carries a longer operating time, greater blood loss and a higher infection rate than internal fixation. However, in its favour is a much lower need for revision surgery (nearly four times less) when compared to internal fixation for stage III and IV fractures. The mortality rates are equivalent for the two groups but there is insufficient data to be certain there is a difference in morbidity (Masson, Parker et al. 2003). Some argue that prosthetic replacement is always preferable for stage III and IV fractures so that patients, particularly the elderly, are subject to one single surgical intervention (Figure 29.9). This is also true for patients with pathological fractures and those in whom closed reduction cannot be achieved.
Hip prostheses used for femoral neck fractures are usually of the femoral part only (hemiarthroplasty) and may be inserted with or without cement. Cemented prostheses have better mobility and less thigh pain; uncemented prostheses should be reserved for the very frail where the pre-injury status suggests that mobility is unlikely to be attained after operation and those who will benefit significantly from the reduced operating time. There is little evidence to support use of bipolar prostheses over unipolar types for the elderly group; the mortality, morbidity and functional recovery following use of either are similar.However, some studies suggest a longer survivorship of bipolar implants and an argument can be made for their use in younger patients.
Total hip replacement for femoral neck fractures may be indicated: (1) if treatment has been delayed for some weeks and acetabular damage is suspected, or (2) in patients with metastatic disease or Paget’s disease. Hip function and quality of life are reported to be better with total hip replacement, even when compared with hemiarthroplasty, and there is some justification for using this as a preferred option in the healthy, active person who needs treatment for a stage III or IV fracture (Keating, Grant et al. 2006).
Postoperatively, breathing exercises and early mobilization are important. Speed of recovery depends largely on how active the patient was before the fracture; after 2–4 months, further improvement is unlikely.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
revision surgery翻修手术
mortality /mɔːrˈtæləti/
n. 死亡数，死亡率；必死性，必死的命运
morbidity /mɔːrˈbɪdəti/
n. 发病率；病态；不健全
hemiarthroplasty半髋关节置换术
cement /sɪˈment/n. 水泥；接合剂；
Cemented prostheses 骨水泥型假体
uncemented prostheses
mobility /moʊˈbɪləti/n. 移动性；机动性；[电子] 迁移率
uncemented prostheses should be reserved for the very frail where the pre-injury status suggests that mobility is unlikely to be attained after operation and those who will benefit significantly from the reduced operating time. 非骨水泥假体应保留给非常虚弱的患者，因为损伤前状态表明手术后不太可能达到活动能力，并且那些将从减少的手术时间中获益的患者。
bipolar prostheses双极假体
unipolar types 单极类型
the mortality, morbidity and functional recovery following use of either are similar.两者的死亡率、发病率和功能恢复是相似的。
survivorship /sərˈvaɪvərʃɪp/n. 生存；生者对死者名下财产的享有权
metastatic disease(肿瘤)转移性疾病
/ˌmetəˈstætɪk/adj. （癌细胞的）转移性的；变形的；新陈代谢的
百度翻译：
人工关节置换术
这种手术比内固定手术时间长，失血量大，感染率高。然而，与III期和IV期骨折的内固定相比，翻修手术的必要性要低得多（几乎少四倍）。两组的死亡率相当，但没有足够的数据来确定发病率的差异（Masson，Parker等人，2003年）。有人认为，对于III期和IV期骨折，最好采用专业的假体置换术，这样患者，尤其是老年人，只需进行一次手术干预（图29.9）。对于病理性骨折和无法闭合复位的患者也是如此。
用于股骨颈骨折的人工髋关节通常仅限于股骨部分（半关节置换术），可使用或不使用水泥。骨水泥假体具有更好的活动性和更少的大腿疼痛；非骨水泥假体应保留给非常虚弱的患者，因为损伤前的状态表明术后不太可能获得活动性，以及那些将从缩短的手术时间中受益匪浅的患者。很少有证据支持老年人使用双极型假体而不是单极型假体；两种假体使用后的死亡率、发病率和功能恢复情况相似。
然而，一些研究表明双极性植入物的存活时间更长，并且可以对其在年轻患者中的使用进行论证。
股骨颈骨折行全髋关节置换术可能是指：（1）如果治疗推迟了几周，并且怀疑髋臼损伤；（2）对于转移性疾病或佩吉特病患者。据报道，即使与半髋关节置换术相比，全髋关节置换术的髋关节功能和生活质量更好，而且对于需要治疗III期或IV期骨折的健康、活跃的人来说，使用全髋关节置换术是一种更好的选择，这是有道理的（Keating，Grant等人，2006年）。
术后，呼吸训练和早期活动是很重要的。恢复速度很大程度上取决于骨折前患者的活动程度；2-4个月后，不太可能有进一步的改善。