骨科英文书籍精读（30）｜骨折早期并发症之血管损伤
VISCERAL INJURY
Fractures around the trunk are often complicated by injuries to underlying viscera, the most important being penetration of the lung with life-threatening pneumothorax following rib fractures and rupture of the bladder or urethra in pelvic fractures. These injuries require emergency treatment.
VASCULAR INJURY
The fractures most often associated with damage to a major artery are those around the knee and elbow, and those of the humeral and femoral shafts. The artery may be cut, torn, compressed or contused, either by the initial injury or subsequently by jagged bone fragments. Even if its outward appearance is normal, the intima may be detached and the vessel blocked by thrombus, or a segment of artery may be in spasm. The effects vary from transient diminution of blood flow to profound ischaemia, tissue death and peripheral gangrene.
Clinical features
The patient may complain of paraesthesia or numbness in the toes or the fingers. The injured limb is cold and pale, or slightly cyanosed, and the pulse is weak or absent. X-rays will probably show one of the ‘highrisk’ fractures listed above. If a vascular injury is suspected an angiogram should be performed immediately; if it is positive, emergency treatment must be started without further delay.
Treatment
All bandages and splints should be removed. The fracture is re-x-rayed and, if the position of the bones suggests that the artery is being compressed or kinked, prompt reduction is necessary. The circulation is then reassessed repeatedly over the next half hour. If there is no improvement, the vessels must be explored by operation– preferably with the benefit of preoperative or peroperative angiography. A cut vessel can be sutured, or a segment may be replaced by a vein graft; if it is thrombosed, endarterectomy may restore the blood flow. If vessel repair is undertaken, stable fixation is a must and where it is practicable, the fracture should be fixed internally.
---from 《Apley’s System of Orthopaedics and Fractures》P687-688
重点词汇整理：
VISCERAL /ˈvɪsərəl/adj. 内脏的；出于本能的；发自肺腑的；粗俗的
trunk /trʌŋk/n. 树干；躯干；
viscera /ˈvɪsərə/n. 内脏；内容（viscus的复数）
penetration/ˌpenəˈtreɪʃn/n. 渗透；突破；侵入；洞察力
pneumothorax /,njʊmə'θɔræks/n. [内科] 气胸
rupture /ˈrʌptʃər/n. 破裂；决裂；疝气vt. 使破裂；断绝；发生疝vi. 破裂；发疝气
urethra /jʊˈriːθrə/n. [解剖] 尿道
contuse /kən'tjʊz/vt. 挫伤；撞伤；捣碎
jagged /ˈdʒæɡɪd/adj. 锯齿状的；参差不齐的v. 使成缺口；使成锯齿状（jag的过去式）
outward appearance 外观；外表
intima /'ɪntɪmə/n. [解剖] 内膜
detach /dɪˈtætʃ/vt. 分离；脱落；派遣；使超然
thrombus /'θrɑmbəs/n. [病理] 血栓
spasm /ˈspæzəm/n. [临床] 痉挛；抽搐；一阵发作
transient/ˈtrænʃnt/n. 瞬变现象；过往旅客；候鸟adj. 短暂的；路过的
diminution /ˌdɪmɪˈnuːʃn/n. 减少，降低；缩小
profound /prəˈfaʊnd/adj. 深厚的；意义深远的；渊博的
ischaemia /is'ki:miə/n. 局部贫血；缺血
peripheral /pəˈrɪfərəl/adj. 外围的；次要的；（神经）末梢区域的n. 外部设备
gangrene/ˈɡæŋɡriːn/n. [外科] 坏疽
paraesthesia /,pærɪs'θiʒə/n. 感觉异常；触觉异常
numbness /ˈnʌmnəs/n. 麻木；麻痹
cyanosed/'saiənəust/adj. 发绀的；绀色的
angiogram /'ændʒiə,ɡræm/n. [特医] 血管造影片
kink/kɪŋk/n. 扭结；奇想；蜷缩vt. 使扭结vi. 扭结
prompt /prɑːmpt/n. 提示，提词；鼓励；催促；v. 提示，鼓励；促进；激起；导致；（给演员）提白adj. 敏捷的，迅速的；立刻的
be explored by operation 手术探查
preferably /ˈprefrəbli/adv. 更合意地，最好是
preoperative or peroperative angiography.术前或术后血管造影。
a vein graft;血管移植物
endarterectomy /,ɛndɑrtə'rɛktəmi/
n. 动脉内膜切除术
restore/rɪˈstɔːr/vi. 恢复；还原vt. 恢复；修复；归还
百度翻译：
内脏损伤
躯干周围骨折常合并下卧脏器损伤，最重要的是肋骨骨折后发生危及生命的气胸，骨盆骨折时膀胱或尿道破裂。这些伤害需要紧急治疗。
血管损伤
与大动脉损伤最常相关的骨折是膝盖和肘部周围的骨折，以及肱骨和股骨干的骨折。动脉可能会被割伤、撕裂、压迫或挫伤，要么是最初的损伤，要么是随后的锯齿状骨碎片。即使其外观正常，内膜也可能分离，血管被血栓阻塞，或有一段动脉痉挛。其影响从短暂的血流减少到严重的缺血、组织死亡和周围坏疽。
临床特征
病人可能会抱怨脚趾或手指感觉异常或麻木。伤者四肢冰冷苍白，或有轻微紫绀，脉搏微弱或消失。X光片可能会显示出上述“高风险”骨折之一。如果预期有血管损伤，应立即进行血管造影；如果是阳性，必须立即开始紧急治疗。
损失
所有绷带和夹板都应该取下。对骨折处进行重新x光检查，如果骨头的位置表明动脉受到压迫或扭结，必须立即复位。然后在接下来的半小时内反复评估循环。如果没有改善，必须通过手术探查血管，最好是术前或术后血管造影。切断的血管可以缝合，或者用静脉移植物代替部分血管；如果发生血栓，动脉内膜切除术可以恢复血流。如果进行血管再配对，必须进行稳定的固定，在可行的情况下，骨折应在内部固定。