骨科英文书籍精读（364）｜踝关节侧副韧带急性损伤的治疗
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。
中国十大名师之一赖世雄老师说过，学习英语没有捷径，少就是多，快就是慢。不要以量取胜，把一个音标、一个单词、一段对话、一篇文章彻底搞透，慢慢积累，你会发现，你并不比每天走马观花的输入大量英文学的差。
Treatment
Initial treatment consists of rest, ice, compression and elevation (RICE), which is continued for 1–3 weeks depending on the severity of the injury and the response to treatment. Cold compresses should be applied for about 20 minutes every 2 hours, and after any activity that exacerbates the symptoms.
More recently the acronym has been extended to 'PRICE’ by adding protection (crutches, splint or brace) and still further to 'PRICER’, adding rehabilitation (supported return to function). The principles remain the same – a phased approach, to support the injured part during the first few weeks and then allow early mobilization and a supported return to function. An advice leaflet for patients is probably helpful.
The use of non-steroidal anti-inflammatory drugs (NSAIDs) in the acute phase can be helpful, with the usual contraindications and caveats. There is evidence that in acute injuries topical non-steroidal anti-inflammatory (NSAI) gels or creams might be as beneficial as oral preparations, probably with a better risk profile.
Functional treatment, i.e. 'protected mobilization’, leads to earlier recovery of all grades of injury – without jeopardizing stability – than either rigid immobilization or early operative treatment.
OPERATIVE TREATMENT
If the ankle does not start to settle within 1 or 2 weeks of starting RICE, further review and investigation are called for. Persistent problems at 12 weeks after injury, despite physiotherapy, may signal the need for operative treatment. Residual complaints of ankle pain and stiffness, a sensation of instability or giving way and intermittent swelling are suggestive of cartilage damage or impinging scar tissue within the ankle. Arthroscopic repair or ligament substitution is now effective in many cases, allowing a return to full function and sports.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
exacerbate /ɪɡˈzæsərbeɪt/vt. 使加剧；使恶化；激怒
exacerbates the symptoms加剧了症状
acronym美 /ˈækrənɪm/n. 首字母缩略词
a phased approach分阶段方法
leaflet /ˈliːflət/n. 小叶；传单;说明书
contraindication /ˌkɑːntrəˌɪndɪˈkeɪʃn/
n. [医] 禁忌症；禁忌征候
caveat /ˈkæviæt/n. 警告；中止诉讼手续的申请；货物出门概不退换；停止支付的广告
oral preparation口服制剂
/ˌprepəˈreɪʃn/n. 预备；准备
Functional treatment, i.e. 'protected mobilization’, leads to earlier recovery of all grades of injury – without jeopardizing stability – than either rigid immobilization or early operative treatment.与刚性固定或早期手术治疗相比，功能治疗，即“保护性活动”，可使各级损伤更早恢复，且不危及稳定性。
intermittent swelling断断续续(间歇性)的肿胀
intermittent /ˌɪntərˈmɪtənt/adj. 间歇的；断断续续的；间歇性
有道翻译（仅供参考，建议自己翻译）：
治疗
初始治疗包括休息、冰敷、加压和抬高（赖斯），根据损伤的严重程度和治疗反应，持续1-3周。冷敷应该每2小时敷20分钟左右，并且在任何加剧症状的活动之后。
最近，通过增加保护（拐杖、夹板或支架），首字母缩略词被扩展到“PRICE”，并进一步扩展到“PRICER”，增加了康复（支持恢复功能）。原则不变——分阶段的方法，在最初几周内支持受伤部分，然后允许早期动员和支持恢复功能。给病人的建议传单可能有用。
在急性期使用非甾体抗炎药（NSAIDs）是有帮助的，通常有禁忌症和注意事项。有证据在急性损伤中，局部非甾体抗炎（NSAI）凝胶或乳膏可能与口服制剂一样有益，可能具有更好的风险预测。
功能性治疗，即“保护性动员”，比僵硬的固定或早期手术治疗能更早地恢复所有级别的损伤，同时“不危及稳定性”。
手术治疗
如果脚踝在开始吃米饭后的1或2周内没有开始稳定，则需要进一步复查和调查。尽管进行了物理治疗，但受伤后12周出现的持续问题可能表明需要手术治疗。踝关节疼痛和僵硬的残余主诉，不稳定或退让感和间歇性肿胀提示软骨损伤或撞击踝关节内的瘢痕组织。关节镜下修复或韧带替代术在许多情况下都是有效的，可以使患者恢复完全的功能和运动。