骨科英文书籍精读（222）｜髋关节后脱位治疗（3）
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。
Type II fracture-dislocations are often treated by immediate open reduction and anatomical fixation of the detached fragment, the rationale being that many large posterior wall fragments either do not reduce well or remain as a cause of instability even after reduction. However, if the patient’s general condition is suspect, or the necessary surgical skills are not available, the hip is reduced closed, as described above. Traction can be applied until conditions are appropriate for surgery – open reduction and internal fixation will remedy the source of instability, return congruity to the joint and remove any trapped bone fragments.
Type III injuries are treated closed, but there may be retained fragments and these should be removed by open operation. Fixation of a comminuted posterior wall is sometimes impossible – if persistent instability is present, referral to a specialist centre, where reconstruction using a segment of iliac crest could be undertaken, is advisable.
Types IV and V are treated initially by closed reduction. The indications for surgery follow the principles already outlined: instability, retained fragments or joint incongruity. In type V injuries, a femoral head fragment may automatically fall into place, and this can be confirmed by post-reduction CT. If the fragment remains unreduced, operative treatment is indicated: a small fragment can simply be removed, but a large fragment should be replaced; the joint is opened, the femoral head dislocated and the fragment fixed in position with a countersunk screw. Postoperatively, traction is maintained for 2–4 weeks and full weightbearing is deferred for 12 weeks.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
detach /dɪˈtætʃ/vt. 分离；派遣；使超然
the rationale being that many large posterior wall fragments either do not reduce well or remain as a cause of instability even after reduction. 其基本原理是，许多大的后壁碎片要么不能很好地复位，要么即使在复位后仍然是不稳定的原因。
remedy/ˈremədi/v. 补救，纠正，改进；治疗n. 补救；疗法；解决办法；（硬币的）公差
congruity /kənˈɡruːəti/n. 适合，调和；一致；全等
incongruity /ˌɪnkənˈɡruːəti/n. 不协调；不一致；不适宜
referral to a specialist centre,转介至专科中心， /rɪˈfɜːrəl/n. 参照；提及；被推举的人；转诊病人；引荐来源（指给某个网站带来了流量的其他网站）
iliac crest髂嵴；髂骨
The indications for surgery follow the principles already outlined:术适应症遵循已概述的原则:
countersunk screw埋头螺丝；沉头螺钉
/ˈkaʊntərsʌŋk/adj. （螺钉）沉头的，埋头的v. 钻孔（countersink 的过去分词）
百度翻译：
II型骨折脱位通常通过立即切开复位和解剖固定分离的骨折片来治疗，其原理是许多大的后壁碎片要么不能很好地复位，要么即使在复位后仍然是不稳定的原因。但是，如果怀疑患者的一般情况，或必要的手术技能不可用，则髋关节复位闭合，如上所述。牵引可以一直持续到适合手术的条件——切开复位和内固定将修复不稳定的根源，使关节恢复一致，并移除任何截留的骨碎片。
III型损伤采用闭合式治疗，但可能有残余碎片，应通过开放式手术移除。粉碎性后壁的固定有时是不可能的-如果持续不稳定，建议转诊到专科中心，在那里可以使用髂嵴节段进行重建。
IV型和V型最初采用闭合还原法治疗。手术适应证遵循的原则已经概述：不稳定，残留碎片或关节不协调。在V型损伤中，股骨头碎片可能会自动下落到位，这可以通过复位后的CT得到证实。如果骨折仍不复位，应进行手术治疗：小碎片可简单取出，大碎片应更换；打开关节，股骨头脱位，用沉头螺钉固定。术后，牵引力维持2-4周，完全负重推迟12周。