骨科英文书籍精读（126）｜腕关节损伤（1）
CARPAL INJURIES
Fractures and dislocations of the carpal bones are common. They vary greatly in type and severity. These should never be regarded as isolated injuries; the entire carpus suffers, and sometimes, long after the fracture has healed, the patient still complains of pain and weakness in the wrist.
The commonest wrist injuries are: sprains of the capsule and ligaments; fracture of a carpal bone (usually the scaphoid); injury of the triangular fibrocartilage complex (TFCC) and distal radio-ulnar joint; dislocations of the lunate or the bones around it; and subluxations and ‘carpal collapse’, which may be acute or chronic.
Clinical assessment
Following a fall, the patient complains of pain in the wrist. There may be swelling or well-marked deformity of the joint. Tenderness should be carefully localized; undirected prodding will confuse both the patient and the examiner. The blunt end of a pencil is helpful in testing for point tenderness. For scaphoid fractures, the ‘jump spot’ is in the anatomical snuffbox and scaphoid tubercle; for scapho-lunate injuries, just beyond Lister’s tubercle; for lunate dislocation, in the middle of the wrist; for triquetral injuries, beyond the head of the ulna; for hamate fractures, at the base of the hypothenar eminence; for triangular fibrocartilage complex injuries, over the dorsum of the ulnocarpal joint. Movements are often limited (more by pain than by stiffness) and they may be accompanied by a palpable catch or an audible clunk.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
scaphoid /ˈskæfɔɪd/n. 舟状骨adj. 船状的，船形的
triangular fibrocartilage complex (TFCC) 三角纤维软骨复合体(TFCC)
lunate /'lʊnet/n. （史前的）半月形工具；月状骨adj. 新月状的；半月形的
well-marked adj. 显眼的；明显的；识别清楚的
localized/ˈloʊkəlaɪzd/adj. 局部的；地区的；小范围的v. 定位（localize的过去分词）
prodding/ˈprɑːdɪŋ/n. 促进；刺激vt. 刺（prod的现在分词）
blunt end of a pencil铅笔的钝头/blʌnt/adj. 钝的，不锋利的；生硬的；直率的vt. 使迟钝
snuffbox /ˈsnʌfbɑːks/n. 鼻烟盒
tubercle /ˈtuːbərkl/n. （皮肤、骨头或植物上的）结节，疣粒，小块茎；（肺）结核结节
palpable /ˈpælpəbl/adj. 明显的；可感知的；易觉察的
百度翻译：
腕关节损伤
腕骨骨折和脱位是常见的。它们在类型和严重程度上差别很大。这些都不应被视为孤立的损伤；整个腕关节都会受到伤害，有时，在骨折愈合很久之后，患者仍然会抱怨手腕疼痛和无力。
最常见的腕关节损伤有：关节囊和韧带扭伤；腕骨（通常是舟状骨）骨折；三角纤维软骨复合体（TFCC）和远侧桡尺关节损伤；月骨或其周围骨脱位；半脱位和“腕关节塌陷”，可能是急性或慢性的。
临床评估
跌倒后，病人抱怨手腕疼痛。关节可能有肿胀或明显的脱臼。触痛应该小心地局限于局部；不直接的刺激会使病人和检查者混淆。铅笔的钝头有助于测试铅笔尖部的触痛程度。对于舟骨骨折，跳跃点在解剖鼻烟盒和舟骨结节处；对于舟骨月骨损伤，在李斯特结节之外；对于月骨脱位，在手腕中部；对于三角骨损伤，在尺骨头部以外；对于钩状骨折，在小鱼际隆起的基部；用于尺骨腕关节背侧三角纤维软骨复合伤。运动经常受到限制（更多的是疼痛而不是僵硬），他们可能伴随着一个可触摸到的卡扣或一个可听见的沉闷声。