骨科英文书籍精读（301）｜膝关节韧带损伤的临床表现（2）
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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Abrasions suggest the site of impact, but bruising is more important and indicates the site of damage. The doughy feel of a haemarthrosis distinguishes ligament injuries from the fluctuant feel of the synovial effusion of a meniscus injury. Tenderness localizes the lesion, but the sharply defined tender spot of a partial tear (usually medial and 2.5 cm above the joint line) contrasts with the diffuse tenderness of a complete one.
The entire limb should be examined for other injuries and for vascular or nerve damage. The most important aspect of the examination is to test for joint stability. Partial tears permit no abnormal movement, but the attempt causes pain. Complete tears permit abnormal movement, which sometimes is almost painless. To distinguish between the two is critical because their treatment is different; if there is doubt, examination under anaesthesia is mandatory.
Sideways tilting (varus/valgus) is examined, first with the knee at 30 degree of flexion and then with the knee straight. Movement is compared with the normal side. If the knee angulates only in slight flexion, there is probably an isolated tear of the collateral ligaments; if it angulates in full extension, there is almost certainly rupture of the capsule and cruciate ligaments as well.
Anteroposterior stability is assessed first by placing the knees at 90 degrees with the feet resting on the couch and looking from the side for posterior sag of the proximal tibia; when present, this is a reliable sign of posterior cruciate damage. Next, the drawer test is carried out in the usual way; a positive drawer sign is diagnostic of a tear, but a negative test does not exclude one. The Lachman test is more reliable;
anteroposterior glide is tested with the knee flexed 15–20 degrees. Rotational stability arising from acute injuries can usually be tested only under anaesthesia.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
Abrasions suggest the site of impact, but bruising is more important and indicates the site of damage. 擦伤表明了撞击的地点，但瘀伤更重要它表明了损伤的地点。
Abrasion /əˈbreɪʒn/n. 磨损；磨耗；擦伤
bruise /bruːz/n. 擦伤；挫伤；青肿vt. 使受瘀伤；使受挫伤vi. 擦伤；受伤
The doughy feel of a haemarthrosis distinguishes ligament injuries from the fluctuant feel of the synovial effusion of a meniscus injury. 关节血肿的软绵绵的感觉区别于韧带损伤和半月板损伤时滑膜积液的波动感觉。
doughy /ˈdoʊi/adj. 面团似的；柔软的；苍白的；半熟的
synovial /si'nəuviəl, sai-/adj. 滑液的；分泌滑液的
effusion/ɪˈfjuːʒn/n. 渗出
tender spot压痛点
diffuse tenderness弥漫性压痛
if there is doubt, examination under anaesthesia is mandatory. 如有疑问，必须在麻醉下检查。
mandatory/ˈmændətɔːri/n. 受托者（等于mandatary）adj. 强制的；托管的；命令的
Sideways tilting侧向倾斜(varus/valgus)
arising from 缘于
百度翻译：
擦伤表明是撞击的部位，但瘀伤更重要，表明是损伤的部位。硬肿的感觉区分韧带损伤和半月板损伤滑膜积液的波动感觉。压痛局限于病变部位，但局部撕裂（通常在关节线上方2.5cm的内侧）的明显压痛点与完全撕裂的弥漫性压痛相反。
应检查整个肢体是否有其他损伤以及血管或神经损伤。检查的最重要方面是测试关节稳定性。局部撕裂不允许有异常运动，但这种尝试会引起疼痛。完全的眼泪允许不正常的运动，有时几乎是无痛的。区分两者至关重要，因为它们的治疗方法不同；如果有疑问，则必须在麻醉下进行检查。
检查侧倾（内翻/外翻），首先膝关节屈曲30度，然后膝关节伸直。运动与正常侧比较。如果膝关节仅在轻微屈曲时成角，则可能存在副韧带的孤立撕裂；如果膝关节在完全伸展时成角，则几乎可以肯定膝关节囊和十字韧带也会断裂。
首先评估前后稳定性，将膝盖放在90度角，双脚放在沙发上，从侧面观察胫骨近端的后凹陷；如果存在，这是后十字损伤的可靠迹象。接下来，按照通常的方法进行抽屉测试；抽屉标志阳性可诊断为撕裂，但阴性测试不排除撕裂。拉赫曼试验更可靠；
测试前后滑翔时膝盖弯曲15-20度。急性损伤引起的旋转稳定性通常只能在麻醉下进行测试。