骨科英文书籍精读（346）｜胫腓骨骨折（1）
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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FRACTURES OF TIBIA AND FIBULA
Because of its subcutaneous position, the tibia is more commonly fractured, and more often sustains an open fracture, than any other long bone.
Mechanism of injury
A twisting force causes a spiral fracture of both leg bones at different levels; an angulatory force produces transverse or short oblique fractures, usually at the same level.
Indirect injury is usually low energy; with a spiral or long oblique fracture one of the bone fragments may pierce the skin from within.
Direct injury crushes or splits the skin over the fracture; this is usually a high-energy injury and the most common cause is a motorcycle accident.
Pathological anatomy
The behaviour of these injuries – and therefore the choice of treatment – depends on the following factors:
1. The state of the soft tissues – The risk of complications and the progress to fracture healing are directly related to the amount and type of soft-tissue damage. Closed fractures are best described using Tscherne’s (Oestern and Tscherne, 1984) method; for open injuries, Gustilo’s grading (Table 30.2) is more useful (Gustilo et al., 1984). The incidence of tissue breakdown and/or infection ranges from 1 per cent for Gustilo type I to 30 per cent for type IIIC.
2. The severity of the bone injury – High-energy fractures are more damaging and take longer to heal than low-energy fractures; this is regardless of whether the fracture is open or closed. Lowenergy breaks are typically closed or Gustilo I or II, and spiral. High-energy fractures are usually caused by direct trauma and tend to be open (Gustilo III A–C), transverse or comminuted.
3. Stability of the fracture – Consider whether it will displace if weightbearing is allowed. Long oblique fractures tend to shorten; those with a butterfly fragment tend to angulate towards the butterfly. Severely comminuted fractures are the least stable of all, and the most likely to need mechanical fixation.
4. Degree of contamination – In open fractures this is an important additional variable.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
subcutaneous /ˌsʌbkjuˈteɪniəs/adj. 皮下的；皮下用的
one of the bone fragments may pierce the skin from within.其中一块骨头碎片可能会从内部刺穿皮肤。
pierce /pɪrs/v. （锋利尖锐物体）刺穿；穿孔于（耳朵、鼻子）；（光、声）穿透，刺破；突破
Gustilo’s grading Gustilo的分级
mechanical fixation机械固定
additional variable附加变量
有道翻译（仅供参考，建议自己翻译）：
胫腓骨骨折
由于它的皮下位置，胫骨比任何其他长骨更容易骨折，更容易发生开放性骨折。
损伤机制
扭力导致两个腿骨在不同水平的螺旋骨折；成角力产生横向或短斜骨折，通常在同一水平。
间接损伤通常是低能量的；螺旋形或长斜形骨折，其中一块骨碎片可能从内部刺穿皮肤。
直接伤害会压碎或撕裂骨折处的皮肤；这通常是一种高能量伤害，最常见的原因是摩托车事故。
病理解剖学
这些损伤的行为以及治疗的选择取决于以下因素：
1、软组织的状态-并发症的风险和骨折愈合的进展与软组织损伤的数量和类型直接相关。闭合性骨折最好用Tscherne（Oestern and Tscherne，1984）方法描述；对于开放性损伤，Gustilo分级（表30.2）更有用（Gustilo et al.，1984）。组织破坏和/或感染的发生率从1%到30%不等。
2、骨损伤的严重程度-高能量骨折比低能量骨折更具破坏性，愈合时间更长；这与骨折是开放性骨折还是闭合性骨折无关。低能断裂通常为闭合型或Gustilo I型或II型，螺旋型。高能量骨折通常是由直接创伤引起的，往往是开放性的（GustiloⅢA–C），横向的或粉碎性的。
3、骨折的稳定性——考虑如果允许负重，它是否会移位。长斜骨折倾向于缩短；有蝴蝶碎片的骨折倾向于向蝴蝶成角。严重粉碎性骨折最不稳定，最可能需要机械固定。
4、污染程度——在开放性骨折中，这是一个重要的附加变量。