骨科英文书籍精读（141）｜手部损伤的一般治疗原则
GENERAL PRINCIPLES OF TREATMENT
Most hand injuries can be dealt with under local or regional anaesthesia; a general anaesthetic is only rarely required.
Circulation
If the circulation is threatened, it must be promptly restored, if necessary by direct repair or vein grafting.
Swelling
Swelling must be controlled by elevating the hand and by early and repeated active exercises.
Splintage
Incorrect splintage is a potent cause of stiffness; it must be appropriate and it must be kept to a minimum length of time. If a finger has to be splinted, it may be possible simply to tape it to its neighbour so that both move as one; if greater security is needed, only the injured finger should be splinted. If the entire hand needs splinting, this must always be in the ‘position of safety’ – with the metacarpo-phalangeal joints flexed at least 70 degrees and the interphalangeal joints almost straight. Sometimes an external splint, to
be effective, would need to immobilize undamaged fingers or would need to hold the joints of the injured finger in an unfavourable position (e.g. flexion of the interphalangeal joints). If so, internal fixation may be required (K-wires, screws or plates).
Skin cover
Skin damage demands wound toilet followed by suture, skin grafting, local flaps, pedicled flaps or (occasionally) free flaps. Treatment of the skin takes precedence over treatment of the fracture.
Nerve and tendon injury
Generally, the best results will follow primary repair of tendons and nerves. Occasionally grafts are required.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
potent /ˈpoʊtnt/adj. 有效的；强有力的，有权势的；有说服力的
appropriate /əˈproʊpriət/adj. 适当的；恰当的；合适的vt. 占用，拨出
metacarpo-phalangeal掌指的，掌骨和指骨的
interphalangeal 指节间的
pedicled flaps 带蒂皮瓣
free flaps游离皮瓣
百度翻译：
一般治疗原则
大多数手部损伤可以在局部或区域麻醉下处理；只有很少需要全身麻醉。
循环
如果循环受到威胁，必须立即恢复，必要时通过直接修复或静脉移植。
肿胀
肿胀必须通过抬手和早期反复的积极锻炼来控制。
夹板
不正确的夹板固定是导致僵硬的一个重要原因；它必须是适当的，并且必须保持在最短的时间内。如果一个手指需要用夹板固定，可以简单地用胶带固定在相邻的手指上，这样两个手指就可以同时活动；如果需要更大的安全性，则只应该用夹板固定受伤的手指。如果整个手需要夹板固定，则必须始终处于“安全位置”——掌骨指骨关节至少弯曲70度，指间关节几乎笔直。有时是一个外夹板有效，需要固定未受损的手指或需要将受伤手指的关节保持在不利位置（例如指间关节屈曲）。如果是这样，可能需要内固定（K-线、螺钉或钢板）。
皮肤覆盖
皮肤损伤需要伤口冲洗，然后进行缝合、植皮、局部皮瓣、带蒂皮瓣或（偶尔）游离皮瓣。皮肤的治疗优先于骨折的治疗。
神经肌腱损伤
一般来说，肌腱和神经的一期修复后效果最好。有时需要移植。