骨科英文书籍精读（44）｜骨折晚期并发症之关节僵硬
JOINT STIFFNESS
Joint stiffness after a fracture commonly occurs in the knee, elbow, shoulder and (worst of all) small joints of the hand. Sometimes the joint itself has been injured; a haemarthrosis forms and leads to synovial adhesions. More often the stiffness is due to oedema and fibrosis of the capsule, ligaments and muscles around the joint, or adhesions of the soft tissues to each other or to the underlying bone. All these conditions are made worse by prolonged immobilization; moreover, if the joint has been held in a position where the ligaments
are at their shortest, no amount of exercise will afterwards succeed in stretching these tissues and restoring the lost movement completely.
In a small percentage of patients with fractures of the forearm or leg, early post-traumatic swelling is accompanied by tenderness and progressive stiffness of the distal joints. These patients are at great risk of developing a complex regional pain syndrome; whether this is an entirely separate entity or merely an extension of the ‘normal’ post-traumatic soft-tissue reaction is uncertain. What is important is to recognize this type of ‘stiffness’ when it occurs and to insist on skilled physiotherapy until normal function is restored.
Treatment
The best treatment is prevention – by exercises that keep the joints mobile from the outset. If a joint has to be splinted, make sure that it is held in the ‘position of safety’ (page 431).
Joints that are already stiff take time to mobilize, but prolonged and patient physiotherapy can work wonders. If the situation is due to intra-articular adhesions, arthroscopic-guided releases may free the joint sufficiently to permit a more pliant response to further exercise. Occasionally, adherent or contracted tissues need to be released by operation (e.g. when knee flexion is prevented by adhesions in and around the quadriceps).
---from 《Apley’s System of Orthopaedics and Fractures》P722
重点词汇整理：
haemarthrosis 关节血肿；关节积血
synovial adhesions滑膜粘连。/si'nəuviəl, sai-/adj. 滑液的；分泌滑液的；滑膜
oedema /ɪˈdiːmə/n. [病理] 水肿
prolonged immobilization;长期制动
physiotherapy /ˌfɪzioʊˈθerəpi/n. 物理疗法
from the outset.从一开始
arthroscopic-guided releases ：关节镜引导下的松解
pliant /ˈplaɪənt/n. 顺从adj. 顺从的；易弯的；易受影响的；能适应的
quadriceps /ˈkwɑːdrɪseps/n. [解剖] 四头肌；股四头肌
百度翻译：
关节僵硬
骨折后关节僵硬通常发生在膝、肘、肩和（最糟糕的）手的小关节。有时关节本身也受到了损伤；形成了血肿并导致滑膜粘连。更常见的是由于关节周围的包膜、韧带和肌肉的水肿和纤维化，或者软组织相互之间或与下垫骨的粘连。所有这些情况都因长时间的固定而恶化；而且，如果关节被固定在韧带的位置上在最短的时间内，再多的运动也不能成功地拉伸这些组织，完全恢复失去的运动。
在小部分前臂或腿部骨折患者中，早期创伤后肿胀伴有远端关节压痛和进行性僵硬。这些患者有很大的风险发展成复杂的局部疼痛综合征；这是一个完全独立的实体，还是仅仅是“正常”创伤后软组织反应的延伸尚不确定。重要的是要认识到这种类型的“僵硬”发生时，坚持熟练的物理治疗，直到正常功能恢复。
治疗
最好的治疗方法是预防——通过从一开始就保持关节活动的锻炼。如果必须用夹板固定关节，请确保其处于“安全位置”（第431页）。
已经僵硬的关节需要时间才能活动起来，但长期而耐心的物理治疗可以创造奇迹。如果这种情况是由于关节内粘连造成的，关节镜引导下的松解可以使关节充分松解，从而允许对进一步运动作出更柔韧的反应。偶尔，需要通过手术释放粘连或收缩的组织（例如，当股四头肌内部和周围的粘连阻止膝关节屈曲时）。