骨科英文书籍精读（3）｜骨折移位和骨折愈合
HOW FRACTURES ARE DISPLACED
After a complete fracture the fragments usually become displaced, partly by the force of the injury, partly by gravity and partly by the pull of muscles attached to them. Displacement is usually described in terms of translation, alignment（此处应该是书写错误，应为angulation，因为下文要分点来论述，详见下文）, rotation and altered length:
· Translation (shift) – The fragments may be shifted sideways, backward or forward in relation to each other, such that the fracture surfaces lose contact. The fracture will usually unite as long as sufficient contact between surfaces is achieved; this may occur even if reduction is imperfect, or indeed even if the fracture ends are off-ended but the bone segments come to lie side by side.
· Angulation (tilt) – The fragments may be tilted or angulated in relation to each other. Malalignment, if uncorrected, may lead to deformity of the limb.
· Rotation (twist) – One of the fragments may be twisted on its longitudinal axis; the bone looks straight but the limb ends up with a rotational deformity.
· Length – The fragments may be distracted and separated, or they may overlap, due to muscle spasm, causing shortening of the bone.
HOW FRACTURES HEAL
It is commonly supposed that, in order to unite, a fracture must be immobilized. This cannot be so since, with few exceptions, fractures unite whether they are splinted or not; indeed, without a built-in mechanism for bone union, land animals could scarcely have evolved. It is, however, naive to suppose that union would occur if a fracture were kept moving indefinitely; the bone ends must, at some stage, be brought to rest relative to one another. But it is not mandatory for the surgeon to impose this immobility artificially – nature can do it with callus, and callus forms in response to movement, not to splintage.
Most fractures are splinted, not to ensure union but to: (1) alleviate pain; (2) ensure that union takes place in good position and (3) permit early movement of the limb and a return of function. The process of fracture repair varies according to the type of bone involved and the amount of movement at the fracture site.
---from 《Apley’s System of Orthopaedics and Fractures》P689-690
重点词汇整理：
the pull of muscles 肌肉的拉力
Displacement is usually described in terms of translation, alignment, rotation and altered length。位移通常用平移、对齐、旋转和改变长度来描述。
Displacemen/dɪsˈpleɪsmənt/n. 取代，移位；
translation /trænzˈleɪʃn/n. 翻译；平移；转化；调任
alignment /əˈlaɪnmənt/n. 队列，对齐、成直线；校准；结盟
reduction is imperfect 复位不完美
Angulation/,æŋgjə'leʃən/n. 使……成角；[测] 测角
tilt /tɪlt/n. 倾斜v. 倾斜
malalignment n. 错乱排列；行列不齐
deformity of the limb肢体畸形
longitudinal axis 纵轴
/ˌlɑːndʒəˈtuːdnl/adj. 长度的，纵向的；经线的
/ˈæksɪs/n. 轴；轴线；轴心国
rotational deformity 旋转畸形
distracted /dɪˈstræktɪd/adj. 注意力分散的；心烦意乱的
v. （使）分心；转移（注意力）
distracted and separated 分离
overlap /ˌoʊvərˈlæp/重叠
muscle spasm 肌肉痉挛 /ˈspæzəm/n. [临床] 痉挛；抽搐；一阵发作
immobilized /ɪ'mobɪ,laɪz/adj. 固定化的v. 使固定（immobilize的过去分词）
splinted /splɪnt/n. 夹板；薄木条；薄金属片vt. 用夹板固定
built-in mechanism 内在机制
scarcely /ˈskersli/adv. 几乎不，简直不；几乎没有；决不；
naive /naɪˈiːv/adj. 天真的 幼稚的
indefinitely /ɪnˈdefɪnətli/adv. 不确定地，无限期地；模糊地，不明确地
the bone ends must, at some stage, be brought to rest relative to one another. 在某些阶段，必须使骨头的两端相对静止。
mandatory /ˈmændətɔːri/n. 受托者（等于mandatary）adj. 强制的；托管的；命令的
immobility /ˌɪməˈbɪləti/n. 不动，固定
artificially /ˌɑːrtɪˈfɪʃəli/adv. 人工地；人为地；不自然地
callus /ˈkæləs/n. [皮肤] 胼胝；愈合组织（骨痂）；老茧
splintage /'splintidʒ/n. [医] 夹板固定
alleviate pain 减轻疼痛 ；止痛
takes place 发生；举行
The process of fracture repair varies according to the type of bone involved and the amount of movement at the fracture site.骨折的修复过程根据所涉及的骨类型和骨折部位的活动量而有所不同。
百度翻译：
骨折如何移位
在完全骨折后，碎片通常会移位，一部分是由于受伤的力量，一部分是由于重力，一部分是由于附着在碎片上的肌肉的拉力。位移通常用平移、对齐、旋转和改变长度来描述：
·平移（移位）–碎片可以相互横向、向后或向前移动，从而使断裂面失去接触。只要表面之间有足够的接触，骨折通常会愈合；即使复位不完美，或者即使骨折端脱离末端，但骨段并排放置，也可能发生这种情况。
·成角（倾斜）–碎片可以相互倾斜或成角。如果不矫正，可能导致肢体畸形。
·旋转（扭曲）–其中一个碎片可能在其纵轴上扭曲；骨骼看起来笔直，但四肢最终出现旋转畸形。
·长度-由于肌肉痉挛，碎片可能会分散和分离，或者重叠，导致骨骼缩短。
骨折如何愈合
一般认为，骨折要愈合，必须固定。这是不可能的，因为除了少数例外，无论骨折是否用夹板连接；事实上，如果没有骨连接的内置机制，陆地动物几乎不可能进化。然而，假设骨折无限期地移动会发生愈合是幼稚的；在某个阶段，骨头末端必须相对彼此静止。但是，对于外科医生来说，人为地施加这种不动性并不是强制性的——大自然可以通过愈伤组织来实现，而愈伤组织的形成是对运动的反应，而不是对夹板的作用。
大多数骨折用夹板固定，不是为了确保愈合，而是为了：（1）减轻疼痛；（2）确保愈合位置良好；（3）允许肢体早期运动和功能恢复。骨折修复的过程根据所涉及的骨类型和骨折部位的运动量而不同。