骨科英文书籍精读（335）｜软骨骨折
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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OSTEOCHONDRAL INJURIES
Osteochondral fractures and osteochondritis dissecans are similar injuries of the articular cartilage and subchondral bone. The knee joint is a common site for both conditions. The lesion is usually located on one of the femoral condyles, the intercondylar groove or the medial facet of the patella, and is thought to be due to the patella striking the opposed articular surface.
OSTEOCHONDRAL FRACTURES
The patient gives a history of patellar dislocation or a blow to the front of the knee. The joint is swollen and aspiration yields blood-stained fluid mixed with fat globules.
Standard anteroposterior and lateral x-rays seldom show the abnormality; if the diagnosis is suspected, tunnel and patellar skyline views are needed, and even then the fracture may be hard to see because the damaged area consists largely of articular cartilage. MRI or arthroscopy will be more helpful.
Treatment
Small fragments should be removed as they may cause symptoms. Larger fragments, and especially those from loadbearing areas, can be reattached with screws (counter-sunk or 'headless’ small fragment screws). Postoperatively a long-leg cast is applied for 2 weeks before movement is allowed.
Sometimes a large area of cartilage damage, or even a crater, is discovered on the anterior intercondylar surface. In the past this was treated by trimming any ragged parts and drilling through the crater to stimulate an inflammatory response ('micro-fracturing’). More recently, cartilage transplantation into these defects has shown promising results.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
the medial facet of the patella髌骨的内侧面
facet /ˈfæsɪt/n. 面；方面；小平面vt. 在…上琢面
fat globule脂肪颗粒（球）
/ˈɡlɑːbjuːl/n. 小滴，液滴，小球体；球状体
loadbearing areas负重区
counter-sunk or 'headless’ small fragment screws埋头或“无头”小碎片螺丝
crater, /ˈkreɪtər/n. 火山口；弹坑vt. 在…上形成坑；取消；毁坏vi. 形成坑；消亡
trimming any ragged parts修剪任何不平整的部分
trim /trɪm/v. 修剪；切除
rag /ræɡ/n. 破布；碎屑vt. 戏弄；责骂
promising results效果良好（效果理想）
有道翻译（仅供参考，建议自己翻译）：
骨软骨损伤
软骨骨折和脱骨软骨炎是关节软骨和软骨下骨的相似损伤。膝关节是两种情况下的常见部位。病变通常位于股骨髁、髁间沟或髌骨内侧，被认为是由于髌骨撞击对侧关节面所致。
骨软骨骨折
患者有髌骨脱位或膝盖前部的打击的病史。关节肿胀，吸入会产生血迹的液体，并与脂肪球混合。
标准的前、外侧x线很少显示异常；如果怀疑诊断，需要隧道和髌骨天际线视图，甚至骨折也很难看到，因为损伤区域主要由关节软骨组成。MRI或关节镜检查将更有用。
治疗
小碎片应清除，因为它们可能引起症状。较大的碎片，特别是来自承重区域的碎片，可以用螺钉（反沉或无头”小碎片螺钉）重新连接。术后，在允许移动之前，应用长腿石膏2周。
有时在髁间前表面发现一大片软骨损伤，甚至是一个坑。过去，这是通过修剪任何破烂的部分和钻穿火山口来刺激炎症反应（“微破裂”）。近年来，软骨移植在这些缺损中已显示出良好的效果。