骨科英文书籍精读（390）｜跟骨关节内骨折的治疗
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。
获取本书全本内容----->请扫描文末二维码，关注公众号并回复“骨折肌肉学”。
中国十大名师之一赖世雄老师说过，学习英语没有捷径，少就是多，快就是慢。不要以量取胜，把一个音标、一个单词、一段对话、一篇文章彻底搞透，慢慢积累，你会发现，你并不比每天走马观花的输入大量英文学的差。
INTRA-ARTICULAR FRACTURES
Undisplaced fractures are treated in much the same way as extra-articular fractures: compression bandaging, ice-packs and elevation followed by exercises and non-weightbearing for 6–8 weeks. As long as vertical stress is avoided, the fracture will not become displaced; cast immobilization is therefore unnecessary and it may even be harmful in that it increases the risk of stiffness and algodystrophy. Good or excellent results can be expected in most patients with undisplaced intra-articular fractures.
Displaced intra-articular fractures are best treated by open reduction and internal fixation as soon as the swelling subsides. CT has greatly facilitated this approach; the medial and lateral fragments can be clearly defined and, with suitable drawings or models, the surgical procedure can be carefully planned and rehearsed.
The operation is usually performed through a single, wide lateral approach; access to the posterior facet and medial fragment is achieved by taking down the lateral aspect of the calcaneum, performing the reduction, and then rebuilding this wall. The various fragments are held with interfragmentary screws – bone grafts are sometimes added to fill in defects. The anterior part of the calcaneum and the calcaneocuboid joint also need attention; the fragments are similarly reduced and fixed. Finally a contoured plate is placed on the lateral aspect of the calcaneum to buttress the entire assembly.The wound is then closed and drained.
Postoperatively the foot is lightly splinted and elevated. Exercises are begun as soon as pain subsides and after about 2 weeks the patient can be allowed up non-weightbearing on crutches. Partial weightbearing is permitted only when the fracture has healed (seldom before 8 weeks) and full weightbearing about 4 weeks after that. Restoration of function may take 6–12 months.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
As long as vertical stress is avoided, the fracture will not become displaced;只要避免了垂直应力，骨折就不会发生位移;
algodystrophy痛性肌萎缩
Displaced intra-articular fractures are best treated by open reduction and internal fixation as soon as the swelling subsides移位关节内骨折最好的治疗方法是肿胀消退后立即切开复位内固定
CT has greatly facilitated this approach;CT极大地促进了这种方法的发展;
facilitate /fəˈsɪlɪteɪt/vt. 促进；帮助；使容易
the surgical procedure can be carefully planned and rehearsed.手术过程可以仔细计划和演练。
rehearse /rɪˈhɜːrs/vt. 排练；预演
access to the posterior facet and medial fragment is achieved by taking down the lateral aspect of the calcaneum, performing the reduction, and then rebuilding this wall.通过取下跟骨外侧，进行复位，然后重建这个壁，可以进入后小关节面和内侧碎片。
calcaneocuboid joint跟骰关节
Finally a contoured plate is placed on the lateral aspect of the calcaneum to buttress the entire assembly. 最后在跟骨的侧面放置一个轮廓板以支撑整个组件。
contoured plate 靠模样板；压型板；护缘板
contour /ˈkɑːntʊr/n. 轮廓；等高线；周线；电路；概要vt. 画轮廓；画等高线
assembly /əˈsembli/n. 装配；集会，集合；组件n. 汇编，编译
DeepL翻译（仅供参考，建议自己翻译）：
关节内骨折
未移位的骨折的治疗方法与关节外骨折基本相同：加压包扎、冰袋和抬高，然后进行锻炼和非负重6-8周。只要避免垂直压力，骨折就不会移位；因此，石膏固定是不必要的，它甚至可能是有害的，因为它增加了僵硬和藻类萎缩的风险。对于大多数没有移位的关节内骨折的病人，可以期待良好或出色的效果。
移位的关节内骨折最好在肿胀消退后立即进行开放复位和内固定治疗。CT为这种方法提供了极大的便利；可以清楚地界定内侧和外侧的碎片，通过合适的图纸或模型，可以仔细计划和演练手术过程。
手术通常是通过单一的、宽阔的外侧入路进行的；通过取下小腿骨的外侧，进行缩小，然后重建这个墙，就可以接触到后方的切面和内侧的碎片。不同的碎片用片段间的螺钉固定--有时添加骨移植来填补缺陷。小腿骨的前半部分和小腿骨关节也需要注意；这些碎片也同样被缩小和固定。最后，在小腿骨的外侧放置一块轮廓板以支撑整个组件。然后关闭伤口并引流。
术后，脚被轻度夹板固定并抬高。疼痛缓解后立即开始锻炼，大约2周后，病人可以拄着拐杖不负重起床。只有在骨折愈合后才允许部分负重（很少在8周前），4周后允许完全负重。功能的恢复可能需要6-12个月。