骨科英文书籍精读（137）｜月骨脱位（2）
Treatment
Closed reduction
The surgeon pulls strongly on the dorsiflexed hand; then, while maintaining traction, he or she slowly palmarflexes the wrist, at the same time squeezing the lunate backwards with his or her other thumb. These manoeuvres usually effect reduction; they also prevent conversion of a perilunate to a lunate dislocation. A plaster slab is applied holding the wrist neutral. Percutaneous K-wires may be needed to hold the reduction.
Open reduction
Reduction is imperative, and if closed reduction fails, or if a later x-ray shows that the wrist has collapsed into the familiar DISI pattern, open reduction is performed. The carpus is exposed by an anterior approach which has the advantage of decompressing the carpal tunnel. While an assistant pulls on the hand, the lunate is levered into place and kept there by a K-wire which is inserted through the lunate into the capitate. If the scaphoid is fractured, this too can be reduced and fixed with a Herbert screw or K-wires. Where possible, the torn soft tissues should be repaired through palmar and dorsal approaches. At the end of the procedure, the wrist is splinted in a plaster slab, which is retained for 3 weeks. Finger, elbow and shoulder exercises are practised throughout this period. The K-wires are removed at 6 weeks.
This injury is frequently accompanied by severe compression of the median nerve, which should be released.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
squeezing /ˈskwiːzɪŋ/n. 挤压；压榨；挤出物v. 挤压，紧握，捏；榨出，挤出；（使）挤入，塞进；勒索；严格限制；向……施加压力（squeeze 的现在分词）
manoeuvres /məˈnuːvər/n. 特技动作，熟练动作；（尤指以欺骗为目的）策略，手段；欺诈性操作；军事演习（等于 maneuver）v. （使谨慎或熟练地）移动；操控，使花招；诱使，诱导
conversion /kənˈvɜːrʒn/n. 转换；变换；[金融] 兑换；改变信仰
slab /slæb/n. 厚板，平板；混凝土路面；厚片vt. 把…分成厚片；用石板铺
imperative /ɪmˈperətɪv/adj. 必要的，不可避免的；紧急的；命令的，专横的；势在必行的；[语]祈使的n. 必要的事；命令；需要；规则；[语]祈使语气
decompressing减压v. （使）解除压力（decompress 的现在分词）
Where possible在可能的情况下;尽可能
This injury is frequently accompanied by severe compression of the median nerve, which should be released.这种损伤常常伴有正中神经受到严重压迫，应予以释放。
百度翻译：
治疗
闭合复位
外科医生用力拉背伸的手；然后，在保持牵引力的同时，他或她慢慢地手掌弯曲手腕，同时用另一个拇指向后挤压月骨。这些动作通常会造成复位；它们也会阻止月骨周围向月骨脱位的转化。石膏板的应用保持手腕中立。可能需要经皮的K-线来保持复位。
开放复位
是必要的，如果闭合复位失败，或者如果后来的x光片显示手腕已经塌陷成熟悉的DISI模式，则进行开放复位。腕关节暴露于前入路，其优点是对腕管减压。当助手拉住手的时候，月牙被撬到合适的位置，并被一根穿过月牙插入头状体的K形金属丝固定在那里。如果舟状骨骨折，这也可以减少和固定赫伯特螺钉或K-线。在可能的情况下，应通过掌侧和背侧入路修复撕裂的软组织。手术结束后，手腕用夹板固定在石膏板上，石膏板保留3周。整个时期都在练习手指、肘部和肩部练习。术后6周取下K-线。
这种损伤常伴有正中神经的严重压迫，应予以松解。