骨科英文书籍精读（212）｜髋臼骨折的保守治疗
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。
NON-OPERATIVE TREATMENT
In recent years opinion has moved in favour of operative treatment for displaced acetabular fractures. However, conservative treatment is still preferable in certain well-defined situations: (1) acetabular fractures with minimal displacement (in the weightbearing zone, less than 3 mm); (2) displaced fractures that do not involve the superomedial weightbearing segment (roof) of the acetabulum – usually distal anterior column and distal transverse fractures; (3) a both-column fracture that retains the ball and socket congruence of the hip by virtue of the fracture line lying in the coronal plane and displacement being limited by an intact labrum; (4) fractures in elderly patients, where closed reduction seems feasible; (5) patients with ‘medical’ contraindications to operative treatment (including local sepsis). Comminution in itself is not a contraindication to operative treatment, provided adequate facilities and expertise are available.
Matta and Merritt (1988) have listed certain criteria which should be met if conservative treatment is expected to succeed: (1) when traction is released, the hip should remain congruent; (2) the weightbearing portion of the acetabular roof should be intact; and (3) associated fractures of the posterior wall should be excluded by CT. Non-operative treatment is more suitable for patients aged over 50 years than for adolescents and young adults.
If there are medical contraindications to operative treatment, closed reduction under general anaesthesia is attempted. In all patients treated conservatively, longitudinal traction, if necessary supplemented by lateral traction, is maintained for 6–8 weeks; this will
unload the articular cartilage and will help to prevent further displacement of the fracture. During this period, hip movement and exercises are encouraged.
The patient is then allowed up, using crutches with minimal weightbearing for a further 6 weeks.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
conservative treatment保守治疗
superomedial 上中段
the ball and socket球窝
congruence/ˈkɑːŋɡruəns/n. 一致；适合；[数] 全等
coronal plane冠状面
labrum /ˈleɪbrəm; ˈlæbrəm/n. [无脊椎] 上唇
feasible /ˈfiːzəbl/adj. 可行的；可能的；可实行的
contraindications [医] 禁忌症（contraindication的复数）
sepsis /ˈsepsɪs/n. 败血症，[医] 脓毒病；腐败作用
congruent; /ˈkɑːŋɡruənt/adj. 适合的，一致的；全等的；和谐的
longitudinal traction纵向牵引
lateral traction横向、侧方牵引
crutches /ˈkrʌtʃɪz/n. 拐杖，支撑物；
百度翻译：
非手术治疗
近年来，有人认为手术治疗移位的髋臼骨折是可行的。然而，在某些明确的情况下，保守治疗仍然是可取的：（1）髋臼骨折最小位移（负重区，小于3mm）；（2） 不累及髋臼上中段负重段（顶板）的移位骨折-通常为远端前柱骨折和远端横向骨折；（3）双柱骨折，由于冠状面上的骨折线和移位受限于完整的上唇；（4）老年患者骨折，闭合复位似乎可行；（5）手术治疗有“医学”禁忌症（包括局部败血症）的患者。粉碎本身并不是手术治疗的禁忌症，只要有足够的设备和专业知识。
Matta和Merritt（1988）列出了保守治疗成功时应满足的某些标准：（1）牵引解除时，髋关节应保持一致；（2）髋臼顶承重部分应完好无损；（3）CT应排除后壁相关骨折。非手术治疗比青少年、青壮年更适合50岁以上患者。
如果手术治疗有医学禁忌症，可尝试在全身麻醉下进行闭合复位。在所有保守治疗的患者中，纵向牵引，必要时辅以侧向牵引，维持6-8周；这将卸下关节软骨，有助于防止骨折进一步移位。在此期间，鼓励髋部运动和锻炼。
然后，患者被允许使用拐杖，并在接下来的6周内保持最小负重。