骨科英文书籍精读（340）｜胫骨平台骨折的治疗(3)
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。
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Types 5 and 6 fractures
These are severe injuries that carry the added risk of a compartment syndrome. A simple bicondylar fracture, in an elderly patient, can often be reduced by traction and the patient then treated as for a type 2 injury – some residual angulation may follow (Fig. 30.22). However, it is more usual to consider stable internal fixation and early joint movement for these injuries, but surgery is not without significant risk. The danger is that the wide exposure necessary to gain access to both condyles may strip the supporting soft tissues, thus increasing the risk of wound breakdown and delayed union or non-union.
New strategies involve spanning the knee joint with an external fixator, thereby providing provisional stability, and waiting for the soft-tissue conditions to improve – sometimes as long as 2–3 weeks. Then a double incision approach (anterior and posteromedial usually) is made, which provides access to the main fracture fragments and limits the amount of subperiosteal elevation carried out if both condyles are
approached through a single anterior incision only. Buttress plates placed in a submuscular fashion are used (Fig. 30.23). An alternative method is to perform the articular reduction through a limited surgical exposure (this can often be done percutaneously) and to stabilize the metaphysis to the diaphysis using a circular external fixator (Fig. 30.24). This approach is less risky and can produce better results (Canadian Orthopaedic Trauma Society, 2006).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
strip /strɪp/v. 脱去衣服；进行脱衣表演；剥去（外皮）
strip soft tissues剥离软组织
provisional stability,临时稳定,
/prəˈvɪʒənl/adj. 临时的，暂时的；暂定的
percutaneously经由皮肤地
有道翻译（仅供参考，建议自己翻译）：
5型和6型骨折
这些都是严重的损伤，会增加室间隔综合征的风险。老年患者的简单双髁骨折通常可以通过牵引复位，然后将患者作为2型损伤进行治疗-可能会出现一些残余角度（图30.22）。然而，对于这些损伤，更常考虑稳定的内固定和早期关节活动，但手术并非没有明显风险。危险在于，接触两侧髁突所需的广泛接触可能会剥离支撑软组织，从而增加伤口破裂和延迟愈合或不愈合的风险。
新的策略包括使用外固定器跨越膝关节，从而提供临时稳定性，并等待软组织状况改善-有时长达2-3周。然后采用双切口入路（通常为前、后内侧入路），以接近主要骨折碎片，并限制骨膜下抬高的数量（如果两个髁都是这样的话）
只有一个前切口。以肌肉下的方式放置支撑板（图30.23）。另一种方法是通过有限的手术进行关节复位局部暴露（通常可经皮进行），并使用环形外固定器将干骺端固定至骨干（图30.24）。这种方法风险较小，可以产生更好的结果（加拿大骨科创伤学会，2006年）。