骨科英文书籍精读（254）｜股骨转子下骨折
我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
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SUBTROCHANTERIC FRACTURES
The part of the femoral shaft around the lesser trochanter is substantially strengthened by a widening cortex and that stout pillar of bone posteromedially, the calcar femorale. Therefore, large forces are needed to cause fractures in this area – and that is usually the case when this injury is diagnosed in young adults. By contrast, in the elderly, who are the second group who sustain this fracture quite frequently, the injury is relatively trivial; here the reason is a weakening of bone in this area by osteoporosis, osteomalacia, Paget’s disease or a secondary deposit.
Subtrochanteric fractures have several features which make them interesting (and challenging to treat):
1. Blood loss is greater than with femoral neck or trochanteric fractures – the region is covered with anastomosing branches of the medial and lateral circumflex femoral arteries which come off the profunda femoris trunk.
2. There may be subtle extensions of the fracture into the intertrochanteric region, which may influence the manner in which internal fixation can be performed.
3. The proximal part is abducted and externally rotated by the gluteal muscles, and flexed by the psoas. The shaft of the femur has to be brought into a position to match the proximal part or else a malunion is created by internal fixation.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
substantially /səbˈstænʃəli/adv. 实质上；大体上；充分地
subtle /ˈsʌtl/adj. 微妙的；精细的；敏感的；狡猾的；稀薄的
calcar femorale股骨距
/'kæl,kɑr/n. 熔炉；鸟翼或鸟腿上的距；花距
trivial /ˈtrɪviəl/adj. 不重要的，琐碎的；琐细的
osteoporosis, osteomalacia, Paget’s disease or a secondary deposit骨质疏松症、骨软化症、佩吉特氏病或继发性沉积
anastomosing branches 吻合的分支
v. （医）吻合，接合血管（anastomose 的现在分词）
circumflex femoral arteries旋股动脉
/ˈsɜːrkəmfleks/n. 音调符号adj. 弯曲的；有声调符号的v. 标有抑扬音符；弯曲
profunda femoris trunk.股深动脉干
/prə'fʌndə/n. 深的动脉或者静脉
manner /ˈmænər/n. 方式；习惯；种类；规矩；风俗
gluteal muscles臀肌
psoas /'səʊæs/n. 腰大肌
The shaft of the femur has to be brought into a position to match the proximal part or else a malunion is created by internal fixation.
股骨干的位置必须与近端相匹配，否则内固定会造成骨折畸形愈合。
or else 否则；要不然
malunion /mæ'lju:njən/n. 畸形愈合；骨不连
百度翻译：
转子下骨折
小粗隆周围的股骨干部分被加宽的皮质和后内侧粗壮的骨柱（股骨距）强化。因此，需要很大的力量来造成这一区域的骨折——这通常是在年轻人被诊断出这种损伤时的情况。相比之下，在老年人中，他们是第二组经常发生这种骨折的人，损伤相对较小；这里的原因是骨质疏松症、骨软化症、佩吉特氏病或继发性沉积导致该区域骨质减弱。
股骨转子下骨折有几个特点，这些特点使其有趣（治疗起来也很有挑战性）：
1、失血量大于股骨颈或大转子骨折——该区域覆盖着旋股内侧和旋股外侧动脉的吻合支，这些动脉来自股深动脉干。
2、骨折可能轻微延伸至股骨转子间区域，这可能影响内固定的方式。
3、近端部分由臀肌外展和外旋，并由腰大肌弯曲。必须将股骨柄置于与近端匹配的位置，否则内固定会造成畸形愈合。