骨科英文书籍精读（305）｜膝关节韧带损伤的治疗（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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COMPLETE TEARS
Isolated tears of the MCL, i.e. where the knee is stable in full extension, usually heal well enough to permit near-normal function. Operative repair is unnecessary. A long cast-brace is worn for 6 weeks and thereafter graded exercises are encouraged.
Isolated tears of the LCL are rare. If the diagnosis is certain, these can be treated conservatively as for MCL tears. If the fibular styloid is avulsed, the injury is probably more severe and involves part of the posterolateral capsule and arcuate complex. Examination for posterolateral instability should be done and, if confirmed, these injuries may benefit from repair. In contrast, a fibular head fracture indicates an avulsion of the LCL as a solitary injury.
Isolated tears of the ACL should, in theory, be treated by early operative reconstruction. Indeed, such are the pressures on professional sportspersons that this is often demanded. Operation may also be indicated for non-professionals if the tibial spine is avulsed; the bone fragment, with the attached ACL, is replaced and fixed under arthroscopic control and the knee is braced for 6 weeks. In all other cases it is more prudent to follow the conservative regime described earlier; the cast-brace is worn only until symptoms subside and thereafter movement and musclestrengthening exercises are encouraged. About half of these patients regain sufficiently good function not to need further treatment. The remainder complain of varying degrees of instability; late assessment will identify those who are likely to benefit from ligament reconstruction.
Isolated tears of the PCL are treated conservatively. Most patients end up with little or no loss of function. However, some experience instability whilst walking up stairs and are sufficiently disabled to warrant late reconstruction.
Combined injuries may result in significant loss of function. With concurrent ACL and collateral ligament injury, reconstruction of the ACL often obviates the need for collateral ligament treatment; however, early operation carries the risk of postoperative joint fibrosis, so it is wiser to start treatment with joint support and physiotherapy in order to restore a good range of movement before following on with ACL reconstruction. A similar approach is adopted for combined injuries involving the PCL, but here all damaged structures will need to be repaired.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
styloid /ˈstaɪˌlɔɪd/n. 茎突；茎状突
avulse /əˈvʌls/v. 抽出；撕裂，撕脱
arcuate complex弓形复合体
arcuate /'ɑrkjʊɪt/adj. 弓形的，弯曲的
non-professionals非专业技术人员
tibial spine胫骨棘；髁间脊（棘）
prudent /ˈpruːdnt/adj. 谨慎的；精明的；节俭的
regime /reɪˈʒiːm/n. 政权，政体；社会制度；管理体制
subside /səbˈsaɪd/vi. 平息；减弱；沉淀；坐下
The remainder complain of varying degrees of instability;其余的则抱怨不同程度的不稳定;
some experience instability whilst walking up stairs and are sufficiently disabled to warrant late reconstruction.有些人在爬楼梯时经历了不稳定，并且严重残疾，需要后期重建。
sufficiently /səˈfɪʃntli/adv. 充分地；足够地
warrant/ˈwɔːrənt/n. 根据；证明；正当理由；委任状vt. 保证；担保；批准；辩解
concurrent /kənˈkɜːrənt/adj. 并发的；一致的；同时发生的；并存的n. [数] 共点；同时发生的事件
obviate /ˈɑːbvieɪt/vt. 排除；避免；消除
similar /ˈsɪmələr/adj. 相似的n. 类似物
百度翻译：
完全的撕裂
MCL的孤立撕裂，即膝盖完全伸展时稳定，通常愈合良好，允许接近正常功能。不需要手术修补。一个长的铸造支撑6周，然后鼓励分级练习。
LCL的孤立撕裂是罕见的。如果诊断是肯定的，这些可以作为保守治疗的MCL眼泪。如果腓骨茎突撕裂，损伤可能更严重，并涉及部分后外侧囊和弓状复合体。应检查后外侧不稳，如果确认，这些损伤可能会从修复中受益。相反，腓骨头骨折表明LCL撕脱伤为孤立性损伤。
孤立性前交叉韧带撕裂，理论上应通过早期手术重建治疗。事实上，这正是职业运动员经常面临的压力。如果胫骨脊柱撕裂，非专业人员也可进行手术；在关节镜控制下，替换并固定带有前交叉韧带的骨碎片，并支撑膝关节6周。在所有其他情况下，更谨慎的做法是遵循前面描述的保守制度；只有在症状消退后才佩戴石膏支具，然后鼓励运动和增强肌肉的锻炼。大约一半的病人恢复了足够好的功能，不需要进一步治疗。其余的抱怨不同程度的不稳定；后期评估将确定哪些人可能受益于韧带重建。
PCL的孤立性撕裂采用保守治疗。大多数患者最终很少或没有功能丧失。然而，有些人在上楼梯时会感到不稳定，并且有足够的残疾来保证后期重建。
合并伤可能导致严重的功能丧失。由于ACL和副韧带同时损伤，重建ACL通常不需要副韧带治疗，但早期手术有术后关节纤维化的风险，因此，在进行前交叉韧带重建之前，最好先进行关节支持和物理治疗，以恢复良好的活动范围。对于涉及PCL的复合伤也采用了类似的方法，但这里所有受损的结构都需要修复。