骨科英文书籍精读（11）｜软组织的重要价值
TREATMENT OF CLOSED FRACTURES
General treatment is the first consideration: treat the patient, not only the fracture. The principles are discussed in Chapter 22.
Treatment of the fracture consists of manipulation to improve the position of the fragments, followed by splintage to hold them together until they unite; meanwhile joint movement and function must be preserved. Fracture healing is promoted by physiological loading of the bone, so muscle activity and early weightbearing are encouraged. These objectives are covered by three simple injunctions:
· Reduce.
· Hold.
· Exercise.
Two existential problems have to be overcome. The first is how to hold a fracture adequately and yet permit the patient to use the limb sufficiently; this is a conflict (Hold versus Move) that the surgeon seeks to resolve as rapidly as possible (e.g. by internal fixation). However the surgeon also wants to avoid unnecessary risks – here is a second conflict (Speed versus Safety). This dual conflict epitomizes the four factors that dominate fracture management (the term ‘fracture quartet’ seems appropriate).
The fact that the fracture is closed (and not open) is no cause for complacency. The most important factor in determining the natural tendency to heal is the state of the surrounding soft tissues and the local blood supply. Low-energy (or low-velocity) fractures cause only moderate soft-tissue damage; high-energy (velocity) fractures cause severe soft-tissue damage, no matter whether the fracture is open or closed.
Tscherne (Oestern and Tscherne, 1984) has devised a helpful classification of closed injuries:
· Grade 0 – a simple fracture with little or no softtissue injury.
· Grade 1 – a fracture with superficial abrasion or bruising of the skin and subcutaneous tissue.
· Grade 2 – a more severe fracture with deep softtissue contusion and swelling.
· Grade 3 – a severe injury with marked soft-tissue damage and a threatened compartment syndrome.
The more severe grades of injury are more likely to require some form of mechanical fixation; good skeletal stability aids soft-tissue recovery.
---from 《Apley’s System of Orthopaedics and Fractures》P695
重点词汇整理：
splintage/'splintidʒ/n. [医] 夹板固定
Fracture healing is promoted by physiological loading of the bone.骨折愈合是由骨的生理负荷促进的
injunctions: [管理] 禁令（injunction的复数）；指令；警告
internal fixation 骨折内固定术
quartet /kwɔːrˈtet/n. 四重奏；四重唱；四件一套
complacency./kəmˈpleɪsnsi/n. 自满；满足；自鸣得意
the state of the surrounding soft tissues and the local blood supply周围软组织和局部血液供应的状态
velocity /vəˈlɑːsəti/n. 【物】速度
a helpful classification of closed injuries闭合性损伤的一个有用的分类
subcutaneous tissue皮下组织
subcutaneous /ˌsʌbkjuˈteɪniəs/adj. 皮下的；皮下用的
contusion /kənˈtuːʒn/n. 挫伤；撞伤；青肿
compartment syndrome 骨筋膜室综合征
mechanical /məˈkænɪkl/adj. 机械的；力学的；呆板的；无意识的；手工操作的
百度翻译：
闭合性骨折的治疗
一般治疗首先要考虑的是：治疗病人，而不仅仅是骨折。第22章讨论了这些原则。
骨折的治疗包括：手法改善骨折块的位置，然后用夹板将骨折块固定在一起，直到骨折块愈合；同时，必须保持关节的运动和功能。骨折愈合是由骨的生理负荷促进的，因此肌肉活动和早期负重被鼓励。这些目标包括三个简单的原则：
·复位。
·固定。
·锻炼。
必须克服两个存在的问题。首先是如何充分固定骨折，同时允许患者充分使用肢体；这是一种冲突（固定与移动），外科医生试图尽快解决（例如通过内固定）。然而，外科医生也希望避免不必要的风险-这里是第二个冲突（速度与安全）。这种双重冲突集中体现了主导骨折治疗的四个因素（术语“骨折四重奏”似乎是合适的）。
骨折是闭合的（而不是开放的）这一事实并不是自满的原因。决定自然愈合趋势的最重要因素是周围软组织的状态和局部血液供应。低能量（或低速度）骨折只造成中等程度的软组织损伤；高能量（速度）骨折造成严重的软组织损伤，无论骨折是开放的还是闭合的。
Tscherne（Oestrn和Tscherne，1984）设计了闭合性损伤的有用分类：
·0级-单纯骨折，软组织损伤小或无损伤。
·1级-皮肤和皮下组织表面擦伤或瘀伤的骨折。
·2级-更严重的骨折伴深部软组织挫伤和肿胀。
·3级-严重损伤，伴有明显的软组织损伤和室间隔威胁综合征。
更严重的损伤等级更可能需要某种形式的机械固定；良好的骨骼稳定性有助于软组织恢复。