骨科英文书籍精读（345）｜近端胫腓关节脱位
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DISLOCATION OF PROXIMAL TIBIOFIBULAR JOINT
A blow or twisting injury may cause subluxation or dislocation of the proximal tibio-fibular joint. Isolated injuries are rare; they usually occur in parachuting or similar activities. Occasionally the condition is habitual and associated with generalized ligamentous laxity.
The fibular head displaces upwards, and either anterolaterally or posteromedially. There is usually pain and local tenderness; the abnormal contour over the lateral aspect of the knee is best seen when the two knees are flexed to 90 degrees on the examination couch. Always check for peroneal nerve injury.
X-ray
In the normal anteroposterior x-ray of the knee the fibular head overlaps the lateral tibial condyle; in a dislocation the fibular head stands clear of the tibia, and in the lateral view the fibular head is displaced either forwards or backwards.
Manual reduction is carried out by flexing the knee to 90 degrees (to relax the lateral collateral ligament) and pressing upon the fibular head; reductions are usually stable and a plaster cylinder is applied for 4 weeks. Recurrent subluxation may call for excision of the fibular head.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
subluxation or dislocation半脱位或全脱位
parachuting /ˈpærəʃuːtɪŋ/n. 跳伞；空降v. 跳伞；紧急任命（parachute 的现在分词）
habitual /həˈbɪtʃuəl/adj. 习惯的；惯常的；习以为常的
habit/ˈhæbɪt/n. 习惯，习性；嗜好vt. 使穿衣
contour /ˈkɑːntʊr/n. 轮廓；等高线；周线；电路；概要vt. 画轮廓；画等高线
in a dislocation the fibular head stands clear of the tibia,脱位后腓骨头脱离胫骨，
Recurrent subluxation may call for excision of the fibular head.复发性半脱位可能需要切除腓骨头。
有道翻译（仅供参考，建议自己翻译）：
近端胫腓关节脱位
击伤或扭伤可导致近端胫腓关节半脱位或脱位。孤立性损伤很少见，通常发生在跳伞或类似活动中。偶尔这种情况是习惯性的，并与全身韧带松弛有关。
腓骨头向上移位，或前外侧移位，或后内侧移位。通常有疼痛和局部压痛；当两个膝盖在检查床上弯曲90度时，膝盖外侧的异常轮廓最明显。经常检查腓神经损伤。
X射线
在正常的膝关节前后位x光片中，腓骨头与胫骨外侧髁重叠；在脱位中，腓骨头远离胫骨，在侧位片中，腓骨头向前或向后移位。
手法复位是通过屈膝90度（放松侧副韧带）并按压腓骨头来进行的；复位通常是稳定的，并使用石膏柱4周。复发性半脱位可能需要切除腓骨头。