骨科英文书籍精读（52）｜骨骺损伤（1）
INJURIES OF THE PHYSIS
In children over 10 percent of fractures involve injury to the growth plate (or physis). Because the physis is a relatively weak part of the bone, joint strains that might cause ligament injuries in adults are liable to result in separation of the physis in children. The fracture usually runs transversely through the hypertrophic or the calcified layer of the growth plate, often veering off into the metaphysis at one of the edges to include a triangular lip of bone. This has little effect on longitudinal growth, which takes place in the germinal and proliferating layers of the physis. However, if the fracture traverses the cellular ‘reproductive’ layers of the physis, it may result in premature ossification of the injured part and serious disturbances of bone growth.
Classification
The most widely used classification of physeal injuries is that of Salter and Harris (Salter and Harris, 1963), which distinguishes five basic types of injury:
· Type 1 – A transverse fracture through the hypertrophic or calcified zone of the plate. Even if the fracture is quite alarmingly displaced, the growing zone of the physis is usually not injured and growth disturbance is uncommon.
· Type 2 – This is essentially similar to type 1, but towards the edge the fracture deviates away from the physis and splits off a triangular metaphyseal fragment of bone (sometimes referred to as the Thurston– Holland fragment).
· Type 3 – A fracture that splits the epiphysis and then veers off transversely to one or the other side, through the hypertrophic layer of the physis. Inevitably it damages the ‘reproductive’ layers of the physis (as these layers are closer to the epiphysis than the metaphysis) and may result in growth disturbance.
· Type 4 – As with type 3, the fracture splits the epiphysis, but it extends into the metaphysis. These fractures are liable to displacement and a consequent misfit between the separated parts of the physis, resulting in asymmetrical growth.
· Type 5 – A longitudinal compression injury of the physis. There is no visible fracture but the growth plate is crushed and this may result in growth arrest.
Rang (Rang, 1969) has added a Type 6, an injury to the perichondrial ring (the peripheral zone of Ranvier), which carries a significant risk of growth disturbance. The diagnosis is made usually in retrospect after development of deformity.
Mechanism of injury
Physeal fractures usually result from falls or traction injuries. They occur mostly in road accidents and during sporting activities or playground tumbles.
Clinical features
These fractures are more common in boys than in girls and are usually seen either in infancy or between the ages of 10 and 12. Deformity is usually minimal, but any injury in a child followed by pain and tenderness near the joint should arouse suspicion, and x-ray examination is essential.
---from 《Apley’s System of Orthopaedics and Fractures》PP729-730
重点词汇整理：
PHYSIS/'faisis/n. 自然界生长原则；后缀生长；骨骺
growth plate生长板
hypertrophic or the calcified layer肥厚或钙化层/,haipə'trɔfik/adj. 肥厚的；过度膨胀的
metaphysis 干骺端；干骨后端
metaphyseal干骺端的
longitudinal /ˌlɑːndʒəˈtuːdnl/adj. 长度的，纵向的；经线的
germinal/'dʒɝmənl/adj. 胚种的；幼芽的；原始的
germinal and proliferating layers 生发和增殖层
premature ossification过早骨化
/ˌpriːməˈtʃʊr,ˌpriːməˈtʊr/n. 早产儿；过早发生的事物adj. 早产的；不成熟的；比预期早的
/ˌɑːsɪfɪˈkeɪʃn/n. 骨化；成骨；（思想的）僵化
metaphyseal干骺端的
veer /vɪr/n. 转向；方向的转变
Inevitably /ɪnˈevɪtəbli/adv. 不可避免地；必然地
misfit /ˈmɪsfɪt/n. 不适合；不适应环境的人vt. 对…不适合
asymmetrical growth.不对称增长。
crushed 压碎的，捣碎的v. 压碎（crush的过去分词）
arrest.逮捕，监禁；停止，中止
perichondrial ring 软骨环
tumble /ˈtʌmbl/vi. 摔倒；倒塌；滚动
arouse suspicion引起怀疑 /səˈspɪʃn/n. 怀疑；嫌疑；疑心；一点儿vt. 怀疑
谷歌翻译：
骺部损伤
儿童骨骺损伤超过10%的骨折涉及生长板(或骨骺)损伤。因为骨骺是骨中相对较弱的部分，可能导致成人韧带损伤的关节拉伤容易导致儿童骨骺分离。骨折通常横穿生长板的肥厚层或钙化层，通常在其中一个边缘转向干骺端，包括一个三角形的骨唇。这对纵向生长几乎没有影响，纵向生长发生在生长板的生发层和增殖层。然而，如果骨折穿过骨骺的细胞“生殖”层，可能会导致损伤部位过早骨化，严重影响骨生长。
分型
骨骺损伤最广泛的分类是Salter和Harris(Salter and Harris，1963)的分类，它区分了五种基本的损伤类型：
·1型-A型横形骨折穿过生长板的肥大或钙化区。即使骨折移位相当惊人，骨骺生长区通常也不会受伤，生长障碍也很少见。
·2型-这本质上类似于类型1，但骨折向边缘偏离骨骺，并分裂出三角形干骺端骨块(有时称为瑟斯顿-霍兰德骨块)。
·3型-骨骺分裂，然后通过骨骺肥厚层横向转向一侧或另一侧的骨折。不可避免地，它会损害骨骺的“生殖”层(因为这些层比干骺端更靠近骨骺)，并可能导致生长障碍。
·4型-和3型一样，骨折会劈开骨骺，但会延伸到干骺端。这些骨折容易移位，继而导致骨骺分离部分之间的不匹配，导致不对称生长。
·5型-骨骺纵向压缩损伤A型。没有明显的骨折，但是生长板被压碎了，这可能会导致生长停滞。
Rang(Rang，1969)增加了一种类型6，软骨环(Ranvier的外围区域)的损伤，这带来了严重的生长障碍风险。通常在畸形发展后进行回顾性诊断。
损伤机制
腓骨骨折通常是由跌倒或牵引损伤引起的。它们大多发生在交通事故、体育活动或游乐场跌倒时。
临床特征
这些骨折在男孩中比女孩更常见，通常见于婴儿期或10至12岁之间。畸形通常很小，但儿童在关节附近出现疼痛和压痛的任何伤害都应该引起怀疑，X光检查是必不可少的。