骨科英文书籍精读（286）｜儿童股骨干骨折的保守治疗
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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Traction and casts
Infants need no more than a few days in balanced traction, followed by a spica cast for another 3–4 weeks. Angulation of up to 30 degrees can be accepted, as the bone remodels quite remarkably with growth. Immediate spica casting has also found favour and this approach does not appear to increase the risk of complications.
Children between 2 and 10 years of age can be treated either with balanced traction for 2–3 weeks followed by a spica cast for another 4 weeks, or by early reduction and a spica cast from the outset. Shortening of 1–2 cm and angulation of up to 20 degrees are acceptable.
Teenagers require somewhat longer (4–6 weeks) in balanced traction, and those aged over 15 (or even younger adolescents if they are large and muscular) may need skeletal traction. Once the fracture feels firm, traction is exchanged for either a spica cast (in the case of upper third and mid-shaft fractures) or a cast-brace (for lower third fractures), which is retained for a further 6 weeks. The position should be checked every few weeks; the limit of acceptable angulation in this age group is 15 degrees in the anteroposterior x-ray and 25 degrees in the lateral.
If a satisfactory reduction cannot be achieved by traction, internal (plates or flexible intramedullary nails) or external fixation is justified. This applies to older children and those with multiple injuries.
儿童骨折大咖治疗方案：
https://m.sohu.com/a/233873024_375318
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
spica cast 人字形石膏
/ˈspaɪkə/ 穗状花序；人字形绷带；角宿一（即室女座α星）
Angulation of up to 30 degrees can be accepted, as the bone remodels quite remarkably with growth.30度的成角是可以接受的，因为随着生长，骨骼会发生明显的重塑。
from the outset. 从一开始
Shortening of 1–2 cm and angulation of up to 20 degrees are acceptable. 缩短1-2厘米和角度高达20度是可以接受的。
flexible intramedullary nails弹性髓内钉
flexible /ˈfleksəbl/adj. 灵活的；柔韧的；易弯曲的
百度翻译：
牵引和石膏
婴儿需要平衡牵引的时间不超过几天，然后再进行3-4周的spica铸型。可以接受高达30度的成角，因为骨骼会随着生长而显著地重塑。直接spica铸造也得到了青睐，这种方法似乎不会增加并发症的风险。
2-10岁的儿童可以进行2-3周的平衡牵引，然后再进行4周的spica铸型，或者从一开始就进行早期复位和spica铸型。缩短1-2厘米和角度高达20度是可以接受的。
青少年需要更长时间（4-6周）的平衡牵引，而15岁以上的青少年（或者更年轻的青少年，如果他们身材高大，肌肉发达）可能需要骨骼牵引。一旦骨折感觉牢固，牵引力被替换为一个spica石膏（在上三分之一和中段骨折的情况下）或一个石膏支架（在下三分之一骨折的情况下），并保留6周。应每隔几周检查一次位置；该年龄组可接受的角度限制为前后x线15度，外侧25度。
如果牵引不能达到满意的复位，内固定（钢板或软髓内钉）或外固定是合理的。这适用于年龄较大的儿童和多发伤的儿童。