骨科英文书籍精读（163）｜手外伤（2）
Tendons must be examined with similar care. Start by testing for ‘passive tenodesis’. When the wrist is extended passively, the fingers automatically flex in a gentle and regular cascade; when the wrist is flexed, the fingers fall into extension. These actions rely upon the balanced tension of the opposing flexor and extensor tendons to the fingers; if a tendon is cut, the cascade will be disturbed.
Active movements are then tested for each individual tendon. Flexor digitorum profundus is tested by holding the proximal finger joint straight and instructing the patient to bend the distal joint. Flexor digitorum superficialis is tested by the examiner holding all the fingers together out straight, then releasing one and asking the patient to bend the proximal joint.Holding the fingers out straight ‘immobilizes’ all the deep flexors (including that of the finger being tested) which have a common muscle belly. However, in the index finger this test is not 100 per cent reliable because the deep flexor is sometimes separate. It is better to ask the patient to make a ‘circle’ between thumb and index (FDP intact) and a ‘buttonhole‘ (FDS intact).
If a tendon is only partly divided, it will still work although it may be painful. In full thickness skin lacerations, if there is any doubt about the integrity of the tendons, the wound should be explored.
X-rays may show fractures, foreign bodies, air or paint.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
the opposing flexor and extensor tendons相对的屈肌腱和伸肌腱
Flexor digitorum profundus指深屈肌
Flexor digitorum superficialis指浅屈肌
laceration /ˌlæsəˈreɪʃnz/n. [外科] 撕裂伤
integrity /ɪnˈteɡrəti/n. 完整；正直；诚实；廉正
百度翻译：
肌腱检查必须同样小心。从测试“被动腱鞘”开始。当腕部被动伸展时，手指会自动以柔和而规则的层叠方式弯曲；当腕部弯曲时，手指进入伸展状态。这些动作依赖于相对的屈肌和伸肌肌腱对手指的平衡张力；如果肌腱被切断，级联会受到干扰。
然后测试每个单独肌腱的主动运动。指深屈肌的测试方法是保持近端手指关节伸直并指导患者弯曲远端关节。指尖浅屈肌的测试是由检查者将所有手指并拢伸直，然后松开其中一根，要求患者弯曲近端联合控股手指伸直“固定”所有深屈肌（包括被测手指的屈肌），这些屈肌都有一个共同的肌腹。然而，在食指上，这项测试并非100%可靠，因为深屈肌有时是分开的。最好让患者在拇指和食指之间画一个“圆圈”（FDP完好无损）和一个“扣眼”（FDS完好无损）。
如果肌腱只是部分分开，它仍然可以工作，尽管它可能会很痛。在全层皮肤移植术中，如果对肌腱的完整性有任何怀疑，应探查伤口。
X光可能显示骨折、异物、空气或油漆。