骨科英文书籍精读（178）｜手外伤（17）

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NERVES 

Late-presenting nerve injuries must be carefully assessed. The results of repair deteriorate with time, particularly for motor nerves where the end plate begins to fail and the muscle begins to fibrose. If several months have passed, tendon transfer may be a more reliable alternative. If nerve repair is attempted, the scar is excised and the stumps pared back until healthy nerve is found proximally and distally; a nerve graft or tubular nerve guide is usually needed to avoid tension at the suture line.

JOINTS 

The proximal interphalangeal joint is most prone to a flexion contracture. Active and passive exercises can be supplemented by serial static splints or dynamic splints. Surgery (capsulotomy, palmar plate and collateral ligament release) may be required but these operations themselves can invite further stiffness. Unstable or painful joints are best fused.

BONES 

Malunion, especially if rotational, may require treatment. Non-union is very uncommon, but if present grafting may be required. Extensor tendons may stick o bone, most commonly after plate fixation of the proximal phalanx.

Plate removal and tenolysis is followed by aggressive active and passive movements: a fair result is usually achieved.

---from 《Apley’s System of Orthopaedics and Fractures》

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重点词汇整理：

deteriorate /dɪˈtɪriəreɪt/vi. 恶化，变坏vt. 恶化

motor nerves 运动神经

alternative /ɔːlˈtɜːrnətɪv/n. 二中择一；供替代的选择adj. 供选择的；选择性的；交替的

pare /per/vt. 消减；削皮；剪；修掉（边等）

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百度翻译：

神经

迟发性神经损伤必须仔细评估。修复的结果会随着时间的推移而恶化，尤其是对于运动神经，终板开始失效，肌肉开始纤维化。如果几个月过去了，肌腱转移可能是一个更可靠的选择。如果试图修复神经，则应切除疤痕，并将残端削去，直到在近端和远端发现健康的神经；通常需要神经移植或管状神经引导，以避免缝合线处出现张力。

关节

近端指间关节最容易发生屈曲挛缩。主动和被动练习可以通过连续的静态夹板或动态夹板来补充。可能需要手术（包膜切开术、掌钢板和颈外韧带松解术），但这些手术本身会导致进一步僵硬。不稳定或疼痛的关节最好融合。

骨头

畸形愈合，尤其是旋转畸形，可能需要治疗。不愈合是非常罕见的，但如果现在需要移植。伸肌肌腱可能粘在o形骨上，最常见于近节指骨钢板固定后。

接骨板取出和腱松解术后进行积极的主动和被动的运动：通常会获得一个公平的结果。

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