骨科英文书籍精读（265）｜成人股骨干骨折保守治疗
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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Adults (and older adolescents) require skeletal traction through a pin or a tightly strung Kirschner wire behind the tibial tubercle. Traction (8–10 kg for an adult) is applied over pulleys at the foot of the bed. The limb is usually supported on a Thomas’ splint and a flexion piece allows movement at the knee (Figure 29.22). However, a splint is not essential; indeed, skeletal traction without a splint (Perkins’ traction) has the advantages of producing less distortion of the fracture and allowing freer movement in bed (Figure 29.23). Exercises are begun as soon as possible.
Once the fracture is sticky (at about 8 weeks in adults) traction can be discontinued and the patient allowed up and partial weightbearing in a cast or brace. For fractures in the upper half of the femur, a plaster spica is the safest but it will almost certainly prolong the period of knee stiffness. For fractures in the lower half of the femur, cast-bracing is suitable. This type of protection is needed until the fracture has consolidated (16–24 weeks).
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
tubercle /ˈtuːbərkl/n. （皮肤、骨头或植物上的）结节，疣粒，小块茎；（肺）结核结节
tibial tubercle胫骨结节
Thomas’ splint /brace托马斯架
百度翻译：
成人（和年龄较大的青少年）需要通过胫骨结节后面的一根针或一根绷紧的克氏针进行骨骼牵引。牵引力（成人为8–10 kg）施加在床脚的滑轮上。四肢通常由托马斯夹板支撑，弯曲部分允许膝盖移动（图29.22）。然而，夹板不是必需的；事实上，不使用夹板的骨骼牵引（Perkins牵引）具有产生较少骨折变形和允许床上更自由运动的优点（图29.23）。演习尽快开始。
一旦骨折发粘（成人在8周左右），可以停止牵引，让患者起来，用石膏或支架部分负重。对于股骨上半部分的骨折，石膏钉是最安全的，但它几乎肯定会延长膝关节僵硬的时间。对于股骨下半部骨折，铸造支撑是合适的。这种类型的保护是需要的，直到骨折愈合（16-24周）。