骨科英文书籍精读（394）｜中足跗骨损伤
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。
Treatment
Ligamentous strains
The foot may be bandaged until acute pain subsides. Thereafter, movement is encouraged. Be prepared to re-examine and re-x-ray the foot that does not settle within a few weeks.
Undisplaced fractures
The foot is elevated to counteract swelling. After 3 or 4 days a below-knee cast or removeable splintage boot is applied and the patient is allowed up on crutches with limited weightbearing.The plaster is retained for 4–6 weeks.
Displaced fractures
An isolated navicular or cuboid fracture is sometimes displaced and, if so, may need open reduction and screw fixation.
Fracture–dislocation
These are severe injuries. Under general anaesthesia, the dislocation can usually be reduced by closed manipulation but holding it is a problem. If there is the least tendency to redisplacement, percutaneous K-wires are run across the joints to fix them in position.
The foot is immobilized in a below-knee cast for 6–8 weeks. Exercises are then begun and should be practised assiduously; it may be 6–8 months before function is regained.
If accurate reduction cannot be achieved by closed manipulation, then open reduction and screw fixation is necessary; the importance of anatomical reduction cannot be overemphasized. However, missed fractures are a lost cause and open reduction will seldom improve the situation in those who present late (more than 3 weeks after injury).
Comminuted fractures
Severely comminuted fractures defy accurate reduction. Attention should be paid to the soft tissues; there is a risk of ischaemia. The foot is splinted in the best possible position and elevated until swelling subsides. Early arthrodesis, with restoration of the longitudinal arch, is advisable, with stable fixation and interpositional bone graft block.
OUTCOME
A major problem with midtarsal injuries is the frequency with which fractures and dislocations are missed at the first examination, resulting in undertreatment and a poor outcome. Even with accurate reduction of midtarsal fracture–dislocations, post-traumatic osteoarthritis may develop and about 50 per cent of patients fail to regain normal function. If symptoms are persistent and intrusive, arthrodesis may be indicated.
距舟关节融合术
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
The foot may be bandaged until acute pain subsides.可以用绷带把脚包扎起来，直到剧烈的疼痛消退。
counteract /ˌkaʊntərˈækt/v. 抵制，抵消，中和
The foot is elevated to counteract swelling. 抬高脚部以消肿。
practised assiduously;刻苦练习;
assiduously /əˈsɪdʒuəsli/adv. 刻苦地；勤勉地
the importance of anatomical reduction cannot be overemphasized解剖复位的重要性怎么强调也不过分
overemphasize/ˌoʊvərˈemfəsaɪz/vt. 过分强调
Severely comminuted fractures defy accurate reduction.严重粉碎性骨折难以准确复位。
defy /dɪˈfaɪ/v. 违抗，不服从；挑战，激；无法，难以（描述或理解）；经受住，顶住
If symptoms are persistent and intrusive, arthrodesis may be indicated.如果症状持续存在并具有侵入性（进展性），可能需要进行关节融合术。
DeepL翻译（仅供参考，建议自己翻译）：
治疗方法
韧带拉伤
脚部可以被包扎，直到急性疼痛消退。此后，鼓励运动。准备对几周内没有恢复的脚进行重新检查和重新拍X光片。
未移位的骨折
抬高脚部以抵消肿胀。3或4天后，使用膝下石膏或可拆除的复古靴，允许病人拄着拐杖起身，并限制负重。
移位性骨折
孤立的舟骨或立方体骨折有时是移位的，如果是这样，可能需要开放复位和螺钉固定。
骨折-脱位
这些是严重的损伤。在全身麻醉的情况下，脱位通常可以通过闭合操作来减少，但保持脱位是一个问题。如果有最小的再移位倾向，可以用经皮的K线穿过关节来固定它们的位置。
脚被固定在膝下石膏中6-8周。然后开始锻炼，应坚持不懈地练习；可能需要6-8个月才能恢复功能。
如果通过闭合操作不能实现准确的复位，那么就必须进行开放复位和螺钉固定；解剖复位的重要性怎么强调都不过分。然而，遗漏的骨折是一种损失，对于那些晚期（受伤后3周以上）出现的骨折，开放复位很少能改善情况。
粉碎性骨折
严重的粉碎性骨折是无法准确复位的。应注意软组织；有缺血的危险。脚被夹板固定在尽可能好的位置并抬高，直到肿胀消退。建议尽早进行关节置换术，恢复纵行足弓，并进行稳定的固定和植骨块的植入。
结果
跖骨中段损伤的一个主要问题是骨折和脱位经常在第一次检查时被漏掉，导致治疗不及时。在第一次检查时漏掉，导致治疗不足 和不良后果。即使准确地减少了 跖骨中段骨折-脱位，也可能出现创伤后骨关节炎，大约50%的病人不能恢复正常功能。如果症状是 如果症状持续存在并具有侵入性，可能需要进行关节置换术。