骨科英文书籍精读（160）｜拇指掌指骨关节尺侧副韧带损伤
ULNAR COLLATERAL LIGAMENT OF THE THUMB METACARPO-PHALANGEAL JOINT (‘GAMEKEEPER’S THUMB’; ‘SKIER’S THUMB’)
In former years, gamekeepers who twisted the necks of little animals ran the risk of tearing the ulnar collateral ligament of the thumb metacarpo-phalangeal joint, either acutely or as a chronic injury. Nowadays this injury is seen in skiers who fall onto the extended thumb, forcing it into hyperabduction. A small flake of bone may be pulled off at the same time. The resulting loss of stability may interfere markedly with prehensile (pinching) activities.
The ulnar collateral ligament inserts partly into the palmar plate. In a partial rupture, only the ligament proper is torn and the thumb is unstable in flexion but still more or less stable in full extension because the palmar plate is intact. In a complete rupture, both the ligament proper and the palmar plate are torn and the thumb is unstable in all positions. If the ligament ruptures completely (usually at its distal attachment to the base of the proximal phalanx), it will not heal unless it is repaired; this is because the proximal end gets trapped in front of the adductor pollicis aponeurosis (the Stener lesion).
Clinical assessment
On examination there is tenderness and swelling precisely over the ulnar side of the thumb metacarpo-phalangeal joint. An x-ray is essential, to exclude a fracture before carrying out any stress tests. Laxity is often obvious but if in doubt, then the joint can be examined under local anaesthetic. If there is no undue laxity (compare with the normal side) in both extension and 30 degrees flexion, then a serious injury can be excluded. If there is more than a few degrees of laxity there is probably a complete rupture which will require operative repair.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
gamekeepers /ˈɡeɪmkiːpər/n. 猎场看守人
skier /ˈskiːər/n. 滑雪的人
hyperabduction过度外展
extension
extend伸展
prehensile /prɪˈhensl/adj. 适于抓握的；善于领会的
pinch /pɪntʃ/n. 捏，拧；少量（非正式）偷窃v. 捏；夹紧
undue /ˌʌnˈduː/adj. 过度的，过分的；不适当的；未到期的
百度翻译：
拇指掌指骨关节尺侧副韧带
在过去的几年里，那些扭伤小动物脖子的饲养员有撕裂拇指掌骨指骨关节的尺侧韧带的风险，可能是急性损伤，也可能是慢性损伤。现在这种损伤在滑雪者中很常见，他们摔倒在伸出的拇指上，迫使拇指过度外展。一小片骨头可能同时脱落。由此造成的稳定性损失可能会严重干扰抓取（捏）活动。
尺侧副韧带部分插入掌板。在部分断裂中，只有韧带撕裂，拇指屈曲不稳定，但由于掌板完整，在完全伸展时仍然或多或少稳定。完全断裂时，韧带和掌板都撕裂，拇指在所有位置都不稳定。如果韧带完全断裂（通常在其远端附着于近节指骨的基底），除非修复，否则不会愈合；这是因为近端被困在拇腱膜内收肌前方（较狭窄的病变）。
临床评估
经检查，拇指掌指骨关节的尺侧有压痛和肿胀。在进行任何应力测试之前，必须进行x光检查，以排除裂缝。松弛通常是明显的，但如果怀疑，则可以在局部麻醉下检查关节。如果在伸展和30度屈曲中没有过度松弛（与正常侧相比），则可以排除严重损伤。如果松弛程度超过几度，则可能是完全破裂，需要手术修理。