骨科英文书籍精读（366）｜踝关节复发性侧方不稳的治疗
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Treatment
Recurrent 'giving way’ can sometimes be prevented by modifying shoe-wear, raising the outer side of the heel and extending it laterally. More effectively, the secondary dynamic ankle stabilizers, the peronei, can be strengthened and brought into play by specific physiotherapy regimes. Ankle exercises to strengthen the peroneal muscles are helpful, and a light brace can be worn during stressful activities.
If, in spite of these measures, the patient continues to experience mechanical instability (true giving way) during everyday activities, reconstruction of the lateral ligament should be considered. More commonly the persisting problem will be functional instability, in which the patient does not trust the ankle, and there are recurrent episodes in which the patient has rapidly or suddenly to unload the ankle, probably because of inhibitory feedback from the injured ankle.
Most patients with functional instability can be improved and returned to sport by arthroscopic debridement of the impinging tissue within the ankle joint, followed by physiotherapy.
Various operations for mechanical stabilization are described; they fall mainly into two groups: (1) those that aim to repair or tighten the ligaments, (2) those that are designed to construct a 'check-rein’ against the unstable movement. The Broström–Karlsson or Gould operation is an example of the first type: the anterior talofibular and calcaneofibular ligaments are exposed and repaired, usually by an overlapping –
or 'double-breasting’ – technique (Karlsson et al., 1988). In the second type of operation a substitute ligament is constructed by using peroneus brevis to act as a tenodesis and prevent sudden movements into varus (Chrisman and Snook, 1969). The disadvantages of the non-anatomic reconstructions are that they sacrifice or partially sacrifice the secondary stabilizers, the peroneal tendons.
Postoperatively the ankle is immobilized in eversion for 2 weeks; a below-knee cast is then applied for another 4 weeks, during which time the patient can bear weight. Thereafter, a removable brace is worn and exercises are encouraged. The brace can usually be discarded after 3 months but it may need to be used from time to time for sports activities.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
peronei,腓骨肌总腱鞘
regime /reɪˈʒiːm/n. 政权，政体；社会制度；管理体制
recurrent episodes反复发作躁狂症
inhibitory feedback from the injured ankle.来自受伤脚踝的抑制反馈。
arthroscopic debridement关节镜下清理术
overlapping or 'double-breasting’ 重叠或“双排扣”
In the second type of operation a substitute ligament is constructed by using peroneus brevis to act as a tenodesis and prevent sudden movements into varus. 在第二类手术中，使用腓骨短肌作为肌腱固定术来构建替代韧带，防止突然向内翻移动。
peroneus /pe'rəuniəs/n. 腓骨肌
a removable brace一个可移动的支具
discard/dɪˈskɑːrd/vt. 抛弃；放弃；丢弃vi. 放弃n. 抛弃；被丢弃的东西或人
有道翻译（仅供参考，建议自己翻译）：
治疗
经常出现的“让路”有时可以通过改变鞋的磨损、抬高脚跟外侧并侧向延伸来防止。更有效地，次级动态踝关节稳定剂，过氧化物酶，可以加强和发挥特定的物理治疗机制。踝关节运动可以增强腓骨肌肉，在紧张活动中可以戴一个轻支撑。
如果尽管采取了这些措施，患者在日常活动中仍会出现机械不稳定（真正的让路），则应考虑重建lat外韧带。更常见的是，持续性问题是功能不稳定，患者不信任踝关节，并且有反复发作，患者迅速或突然卸下脚踝，可能是由于受伤脚踝的抑制性反馈。
大多数功能不稳定患者可以通过关节镜下清除踝关节内撞击组织，然后进行理疗，以改善和恢复运动。
描述了机械稳定的各种操作；主要分为两组：（1）修复或收紧韧带的组，（2）设计用于构建抗不稳定运动的“检查缰绳”。布罗斯特öm–Karlson或Gould手术是第一种类型的一个例子：前滑骨和跟骨腓骨韧带外露并修复，通常通过重叠的方式进行-
或“双面包刺”——技术（Karlson等人，1988）。在第二种手术中，用腓骨短肌作为腱鞘炎，防止突然运动到内翻，来构建替代韧带（Chrisman和Snook，1969）。非解剖重建的缺点是，他们牺牲或部分牺牲了次级刺入器，腓骨肌腱。
术后踝关节外翻固定2周；然后再进行膝下石膏4周，在此期间患者可以承受体重。此后，佩戴可拆卸的支撑，并鼓励进行锻炼。撑杆通常可以在3个月后丢弃，但可能需要不时地用于体育活动。