骨科英文书籍精读（310）｜膝关节韧带慢性损伤的临床表现（3）
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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The examiner is then able to control both knee flexion and the amount of varus or valgus thrust applied; perform the test first with the knee straight and then flexed at 30 degrees. This manner of performing varus and valgus stressing enables even large limbs to be held and examined.
Next, place the knees at 90 degrees with the soles of the feet flat on the couch and the heels lined up; the quadriceps should be relaxed. Looking from the side, note if there is any posterior sag of the upper tibia by checking the levels of the tibial tuberositieson each leg – a posterior sag is a sure sign of posterior cruciate laxity. Then support the patient’s thigh in this position to ensure the hamstring muscles are relaxed, and use the other hand to grasp the patient’s ankle (Fig. 30.6b). Ask the patient to slide the foot slowly down the couch while resisting this movement by holding on to the ankle as the quadriceps contracts, the posterior sag is pulled up and the proximal tibia shifts forward. This is the quadriceps active test (Daniel et al., 1988).
Again with the knees flexed at 90 degrees and both feet resting on the couch (it is useful to sit across the couch to prevent the feet sliding forward), grasp the upper tibia with both hands, and making sure the hamstrings are relaxed, test for anterior and posterior laxity (the drawer sign). A more reliable test for anterior cruciate laxity is to examine for anterior–posterior displacement with the knee flexed to 20 degrees (the Lachman test). Hold the calf with one hand and the thigh with the other, and try to displace the joint backwards and forwards.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
manner/ˈmænər/n. 方式；习惯；种类；规矩；风俗
place the knees at 90 degrees with the soles of the feet flat on the couch and the heels lined up;膝盖成90度，脚底平放在沙发上，脚跟对齐;
sole /soʊl/adj. 唯一的；（尤指女性）未婚的；单独的n. 脚底；鞋底（不包括后跟）；脚趾和脚弓之间的部分；
quadriceps/ˈkwɑːdrɪseps/股四头肌
tibial tuberosities胫骨粗隆
posterior cruciate laxity 后交叉韧带松弛
hamstring muscles腿后肌群
hamstring /ˈhæmstrɪŋ/n. 腿筋vt. 切断腿筋使成跛腿；使残废
slide /slaɪd/v. 滑动；平稳地走
calf /kæf/n. [解剖] 腓肠，小腿；小牛；小牛皮；(鲸等大哺乳动物的)幼崽
百度翻译：
然后，检查者能够控制膝关节屈曲和内翻或外翻推力的大小；首先进行测试，使膝关节伸直，然后弯曲30度。这种对内翻和外翻施压的方式使得即使是大的肢体也能被握住和检查。
接下来，膝盖呈90度角，脚底平放在沙发上，脚后跟对齐；股四头肌应放松。从侧面看，通过检查每条腿的胫骨粗隆水平，注意胫骨上部是否有任何后凹——后凹是后交叉韧带松弛的明确标志。然后在此位置支撑患者的大腿，以确保腘绳肌放松，并用另一只手抓住患者的脚踝（图30.6b）。当股四头肌收缩，后凹向上拉，胫骨近端向前移动时，要求患者缓慢地将脚滑下沙发，同时通过抓住脚踝来抵抗这种运动。这是股四头肌活动试验（Daniel等人，1988）。
再次将膝盖弯曲90度，双脚放在沙发上（坐在沙发上防止双脚向前滑动很有用），用双手抓住胫骨上部，确保腘绳肌放松，测试前后松弛度（抽屉征）。前交叉韧带松弛的一个更可靠的测试是在膝关节弯曲20度时检查前后移位（拉赫曼测试）。一只手握住小腿，另一只手握住大腿，并尝试前后移动关节。