骨科英文书籍精读(380)|距骨损伤

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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INJURIES OF THE TALUS

Talar fractures and dislocations are relatively uncommon. They usually involve considerable violence – car accidents in which the occupants are thrown against the resistant frame of the vehicle, falls from a height, or severe wrenching of the ankle. The injuries include fractures of the neck, body, head or bony processes of the talus, dislocations of the talus or the joints around the talus, osteochondral fractures of the superior articular surface, and a variety of chip or avulsion fractures.

The significance of the more serious injuries is enhanced by two important facts: (1) the talus is a major weightbearing structure (the superior articular surface carries a greater load per unit area than any other bone in the body); (2) it has a vulnerable blood supply and is a relatively common site for post-traumatic ischaemic necrosis.

Blood vessels enter the bone from the anterior tibial, posterior tibial and peroneal arteries, as well as anastomotic vessels from the surrounding capsule and ligaments. The head of the talus is richly supplied by intraosseous vessels. However, the body of the talus is supplied mainly by vessels that enter the talar neck from the tarsal canal and then run retrograde from distal to proximal. In fractures of the talar neck these vessels are divided; if the fracture is displaced, the extraosseous plexus too may be damaged and the body of the talus is at risk of ischaemia.

Mechanism of injury

Fracture of the talar neck is produced by violent hyperextension of the ankle. The neck of the talus is forced against the anterior edge of the tibia, which acts like a cleaver. If the force continues, the fracture is displaced and the surrounding joints may sublux or dislocate.

Fracture of the body is usually a compression injury due to a fall from a height, or an everting force across the body, fracturing the lateral process (the snowboarders’ fracture). Avulsion fractures are associated with ligament strains around the ankle and hindfoot.

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


重点词汇整理:

chip or avulsion fractures碎裂或撕脱性骨折

vulnerable  /ˈvʌlnərəbl/adj. 易受攻击的,易受……的攻击;易受伤害的;有弱点的

the anterior tibial, posterior tibial and peroneal arteries,胫前,胫后,腓总动脉,

anastomotic vessels 吻合血管

/,ænəstə'mɔtik/adj. 吻合的

retrograde  /ˈretrəɡreɪd/adj. 倒退的;退化的;次序颠倒的vi. 逆行;倒退;退步vt. 使倒退adv. 倒退地;向后地

tarsal /'tɑ:səl/adj. 跗骨的;眼睑软骨的n. 跗骨

talar距骨的

talus/ˈteɪləs/n. 距骨;踝;斜面

Fracture of the talar neck is produced by violent hyperextension of the ankle距骨颈骨折是踝关节剧烈过伸造成的


有道翻译(仅供参考,建议自己翻译):

距骨损伤

距骨骨折和脱位相对不常见。它们通常涉及相当大的暴力行为——车祸中,车上的人被扔到有抵抗力的车架上,从高处坠落,或者脚踝严重扭伤。损伤包括颈部、身体、头部或距骨骨突骨折,距骨或距骨周围关节脱位,上关节面骨软骨骨折,以及各种切屑或撕脱骨折。

两个重要事实增强了更严重损伤的重要性:(1)距骨是一个主要的承重结构(上关节面承受的单位面积载荷比身体内任何其他骨骼都大)(2) 它有一个脆弱的血液供应,是一个相对常见的创伤后缺血性坏死的地点。

血管从胫前动脉、胫后动脉和腓动脉进入骨骼,吻合血管从周围的囊和韧带进入。距骨的头部有丰富的骨内血管供应。然而,距骨体主要由血管供应,这些血管从跗管进入距骨颈,然后从远侧向近侧逆行。在距骨颈骨折中,这些血管是分开的;如果骨折移位,骨外神经丛也可能受损,距骨体有缺血的危险。

损伤机制

距骨颈骨折是由于踝关节剧烈过度伸展造成的。距骨的颈部被压在胫骨的前边缘,就像一把劈刀。如果这种力持续下去,骨折就会移位,周围的关节可能会出现半脱位或脱臼。

身体的骨折通常是由于从高处坠落造成的压迫性损伤,或是由于身体受到的外翻力造成的侧向过程破裂(雪人骨折)。撕脱骨折与踝关节和后脚周围的韧带拉伤有关。


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