骨科英文书籍精读（188）｜骨盆损伤（8）
ISOLATED FRACTURES
Avulsion fractures
A piece of bone is pulled off by violent muscle contraction; this is usually seen in sportsmen and athletes. The sartorius may pull off the anterior superior iliac spine, the rectus femoris the anterior inferior iliac spine, the adductor longus a piece of the pubis, and the hamstrings part of the ischium. All are essentially muscle injuries, needing only rest for a few days and reassurance.
Pain may take months to disappear and, because there is often no history of impact injury, biopsy of the callus may lead to an erroneous diagnosis of a tumour. Rarely, avulsion of the ischial apophysis by the hamstrings may lead to persistent symptoms, in which case open reduction and internal fixation is indicated (Wootton, Cross and Holt, 1990).
Direct fractures
A direct blow to the pelvis, usually after a fall from a height, may fracture the ischium or the iliac blade. Bed rest until pain subsides is usually all that is needed.
Stress fractures
Fractures of the pubic rami are fairly common (and often quite painless) in severely osteoporotic or osteomalacic patients. More difficult to diagnose are stress fractures around the sacroiliac joints; this is an uncommon cause of ‘sacroiliac’ pain in elderly osteoporotic individuals and long distance runners. Obscure stress fractures are best demonstrated by radioisotope scans.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
sartorius /sɑr'tɔrɪəs/n. 缝匠肌
anterior superior iliac spine髂前上棘
anterior inferior iliac spine髂前下棘
ischium /'ɪskɪəm/n. [解剖] 坐骨
biopsy /ˈbaɪɑːpsi/n. 活组织检查；活组织切片检查；切片检查法
subside /səbˈsaɪd/vi. 平息；减弱；沉淀；坐下
osteoporotic骨质疏松的
osteomalacic骨软化的
Obscure /əbˈskjʊr/adj. 昏暗的，朦胧的；晦涩的，不清楚的；隐蔽的；不著名的，无名的vt. 使…模糊不清，掩盖；隐藏；使难理解
Obscure stress fractures隐匿性应力性骨折
radioisotope scans.放射性同位素扫描。
百度翻译：
孤立性骨折
撕脱骨折
一块骨头被剧烈的肌肉牵引拉扯下来；这通常见于运动员和运动员。缝匠肌可拔出髂前上棘、股直肌、髂前下棘、耻骨长内收肌、坐骨肌腱。基本上都是肌肉损伤，只需要休息几天就可以安心了。
疼痛可能需要几个月才能消失，而且由于通常没有撞击伤的病史，所以对骨痂进行活检可能会导致对肿瘤的错误诊断。很少情况下，腘绳肌撕裂坐骨隆起可能导致持续症状，在这种情况下，需要切开复位和内固定（Wootton，Cross和Holt，1990）。
直接骨折
骨盆受到直接打击，通常是从高处坠落后，可能导致坐骨或髂骨刀片骨折。通常只需要卧床休息直到疼痛减轻。
应力断裂
耻骨支骨折在严重骨质疏松或骨质疏松的病人中相当常见（而且通常是无痛的）。更难诊断的是骶髂关节周围的应力性骨折；这是老年骨质疏松患者和长跑运动员“骶髂关节”疼痛的罕见原因。不明显的应力骨折最好用放射性同位素扫描来显示。