骨科英文书籍精读（309）｜膝关节韧带慢性损伤的临床表现（2）
我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
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In the less common posterior cruciate insufficiency, symptoms are mild unless the arcuate ligament complex also is torn or stretched; instability is sometimes felt only on climbing stairs.
The joint looks normal apart from slight wasting; there is rarely tenderness but excessive movement in one or more directions can usually be demonstrated. Comparison with the normal knee is essential. A useful routine is to observe gait and knee posture in standing, then to examine for hyperextension, then for increased tilting into varus or valgus (at 0 and 30 degrees knee flexion), followed by the drawer tests and the more specific Lachman test (see later), and finally to perform special tests for rotational instability.
Start by watching the patient walk and noting knee posture and movement in the stance phase. Then ask the patient to stand on one leg – those with severe instabilities may not be able to achieve this task, whereas others who do may demonstrate the problem.
Hyperextension is tested with the patient supine and the knee straight; with the patient relaxed, lift each heel in turn. Repeat the test, but this time grasp the medial forefoot – if the tibia sags posteriorly and externally rotates, this suggests that both posterior cruciate and posterolateral capsule are torn (posterolateral rotatory instability).
To test stability in the coronal plane, the patient’s ankle is tucked under the examiner’s armpit whilst both hands support the knee by straddling it on either side (Fig. 30.6a).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
gait/ɡeɪt/n. 步法，步态vt. 训练步法
stance phase.起步相,步态站立期
stance /stæns/n. 立场；姿态；位置；准备击球姿势
phase /feɪz/n. 月相；时期，阶段
supine /ˈsuːpaɪn/adj. 仰卧的；懒散的；掌心向上的；向后靠的；消极的；苟安的adv. 仰卧地
if the tibia sags posteriorly and externally rotates, this suggests that both posterior cruciate and posterolateral capsule are torn如果胫骨后侧下垂并向外侧旋转，这表明后交叉和后外侧囊撕裂
sag /sæɡ; sɑːɡ/v. （尤指由于承重或受压）中间下垂，下凹
To test stability in the coronal plane, the patient’s ankle is tucked under the examiner’s armpit whilst both hands support the knee by straddling it on either side。
为了检测冠状面稳定性，将患者的踝关节夹在检查者的腋下，同时双手跨坐在两侧支撑膝关节
coronal plane冠状面
armpit /ˈɑːrmpɪt/n. 腋窝
百度翻译：
在不太常见的后交叉韧带功能不全，症状是轻微的，除非弓状韧带复合体也撕裂或拉伸；不稳定有时感觉只有在爬楼梯。
除了轻微的消瘦外，关节看起来正常；很少有压痛，但通常可以显示一个或多个方向的过度运动。与正常膝盖比较是必要的。一个有用的常规是观察站立时的步态和膝盖姿势，然后检查是否过度伸展，然后检查是否向内翻或外翻倾斜增加（屈膝0度和30度），然后进行抽屉试验和更具体的拉赫曼试验（见下文），最后进行旋转不稳的特殊试验。
从观察患者走路开始，注意站立阶段的膝盖姿势和运动。然后让患者单腿站立-那些严重不稳定的患者可能无法完成这项任务，而其他人可能会证明存在问题。
在患者仰卧且膝盖伸直的情况下测试过度伸展；在患者放松的情况下，依次抬起每个脚后跟。重复测试，但这次抓住前脚掌内侧-如果胫骨向后下垂，外部旋转，这表明后十字韧带和后外侧囊撕裂（后外侧旋转不稳定）。
为了测试冠状面上的稳定性，将患者的脚踝夹在检查者的腋下，同时双手跨在膝盖两侧支撑膝盖（图30.6a）。