骨科英文书籍精读（361）｜踝关节韧带损伤
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ANKLE LIGAMENT INJURIES
Ankle sprains are the most common of all sportsrelated injuries, accounting for over 25 per cent of cases. They are probably even more common in pedestrians and country walkers who stumble on stairways, pavements and potholes.
In more than 75 per cent of cases it is the lateral ligament complex that is injured, in particular the anterior talofibular and calcaneofibular ligaments. Medial ligament injuries are usually associated with a fracture or joint injury.
A sudden twist of the ankle momentarily tenses the structures around the joint. This may amount to no more than a painful wrenching of the soft tissues – what is commonly called a sprained ankle. If more severe force is applied, the ligaments may be strained to the point of rupture. With a partial tear, most of the ligament remains intact and, once it has healed, it is able to support the weight of the body. With a complete tear, the ligament may still heal but it never regains its original form and the joint will probably be unstable.
Functional anatomy
The lateral collateral ligaments consist of the anterior talofibular, the posterior talofibular and (between them) the calcaneofibular ligaments. The anterior talofibular ligament (ATFL) runs almost horizontally from the anterior edge of the lateral malleolus to the neck of the talus; it is relaxed in dorsiflexion and tense in plantarflexion. In plantarflexion the ligament essentially changes its orientation from horizontal with respect to the floor, to almost vertical. Thus the ligament at greatest stretch, and most vulnerable, with the foot plantar-flexed is the ATFL – hence the propensity for ATFL injury with the plantar-flexed, inverting, foot (down a pot-hole, off a kerb, etc). The calcaneofibular ligament stretches from the tip of the lateral malleolus to the posterolateral part of the calcaneum, thus it helps also to stabilize the subtalar joint. Maximum tension is produced by inversion and dorsiflexion of the ankle. The posterior talofibular ligament runs from the posterior border of the lateral malleolus to the posterior part of the talus.
The medial collateral (deltoid) ligament consists of superficial and deep portions. The superficial fibres spread like a fan from the medial malleolus as far anteriorly as the navicular and inferiorly to the calcaneum and talus. Its chief function is to resist eversion of the hindfoot. The deep portion is intra-articular, running directly from the medial malleolus to the medial surface of the talus. Its principal effect is to prevent external rotation of the talus. The combined action of restraining eversion and external rotation makes the deltoid ligament the major stabilizer of the ankle.
The distal tibiofibular joint is held by four ligaments: anterior, posterior, inferior transverse and the interosseous 'ligament’, which is really a thickened part of the interosseous membrane. This strong ligament complex still permits some movement at the tibio - fibular joint during flexion and extension of the ankle.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
pavements and potholes.人行道和凹坑。
pavement /ˈpeɪvmənt/n. 人行道
pothole/ˈpɑːthoʊl/n. 壶穴vi. 探索洞穴
anterior talofibular and calcaneofibular ligaments. 距腓前韧带距腓前韧带和跟腓前韧带
calcaneofibular跟腓的
calcaneus /kæl'kenɪəs/ 跟骨；
A sudden twist of the ankle momentarily tenses the structures around the joint.踝关节的突然扭曲会使关节周围的结构瞬间绷紧。
This may amount to no more than a painful wrenching of the soft tissues这可能仅仅是软组织的疼痛
amount to/əˈmaʊnt tu/
相当于，总计为
no more than 只是；仅仅
lateral malleolus 外踝
/məˈliələs/n. [解剖] 踝
dorsiflexion and tense in plantarflexion背屈和跖屈紧张
vulnerable /ˈvʌlnərəbl/
adj. 易受攻击的，易受……的攻击；易受伤害的；有弱点的
propensity /prəˈpensəti/n. 倾向，习性；癖好，偏爱
subtalar joint] 距下关节
The medial collateral (deltoid) ligament内侧副韧带(三角韧带)
deltoid /ˈdeltɔɪd/n. 三角肌adj. 三角形的
navicular /nəˈvɪkjələr/adj. [解剖] 舟状的，船状的n. 舟骨
Its chief function is to resist eversion of the hindfoot.它的主要功能是防止后脚外翻。
eversion /ɪ'vɜːrʃən/n. 翻转，外翻
hindfoot后足
principal effect主要作用
chief function主要功能
The distal tibiofibular joint is held by four ligaments: anterior, posterior, inferior transverse and the interosseous 'ligament’,远端胫腓关节由四根韧带支撑:前、后、下横韧带和骨间“韧带”，
有道翻译（仅供参考，建议自己翻译）：
踝关节韧带损伤
踝关节扭伤是所有运动相关损伤中最常见的，占25%以上的病例。他们可能更常见的行人和乡间步行者谁绊倒在楼梯，人行道和坑洞。
在75%以上的病例中，损伤的是外侧韧带复合体，尤其是距腓前韧带和跟腓韧带。内侧韧带损伤通常与骨折或关节损伤有关。
脚踝的突然扭动瞬间使关节周围的结构紧张。这可能无异于软组织的痛苦扭伤——通常被称为脚踝扭伤。如果施加更大的力，韧带可能会绷紧到断裂点。部分撕裂后，大部分韧带保持完整，一旦愈合，就能支撑身体的重量。如果韧带完全撕裂，韧带可能仍然会愈合，但它永远不会恢复原来的形态，关节可能会不稳定。
功能解剖学
外侧副韧带包括距腓前韧带、距腓后韧带和跟腓韧带。距腓前韧带（ATFL）几乎水平地从外踝前缘到距骨颈部；背屈时放松，跖屈时紧张。在足底屈曲中，韧带的方向从与地板水平的方向逐渐改变为几乎垂直的方向。因此，足底弯曲时，韧带伸展最大、最脆弱的部位是ATFL——因此，足底弯曲、内翻、足部（掉进坑洞、离开路缘等）时，ATFL容易受伤。跟腓韧带从外踝尖端延伸至踝关节后外侧，因此也有助于稳定距下关节。踝关节的内翻和背伸产生最大的张力。距腓骨后韧带从外踝后缘到距骨后部。
内侧副韧带由浅部和深部组成。浅表纤维像扇形一样从内踝扩散到舟骨的前方，从跟骨和距骨的下方。它的主要功能是防止后脚外翻。深部是关节内的，直接从内踝到距骨的内表面。其主要作用是防止距骨外旋。抑制外翻和外旋的联合作用使三角肌韧带成为踝关节的主要稳定点。
远端胫腓关节由四条韧带支撑：前、后、下横韧带和骨间“韧带”，它实际上是骨间膜的加厚部分。这种强大的韧带复合体在踝关节屈曲和伸展时仍然允许胫腓关节的一些运动。