骨科英文书籍精读（51）｜骨折晚期并发症之病理骨折（3）
Treatment
The principles of fracture treatment remain the same: reduce, hold, exercise. However the choice of method is influenced by the condition of the bone; and the underlying pathological disorder may need treatment in its own right (see Chapter 9).
Generalized bone disease In most of these conditions (including Paget’s disease) the bones fracture more easily, but they heal quite well provided the fracture is properly immobilized. Internal fixation is therefore advisable (and for Paget’s disease almost essential). Patients with osteomalacia, hyperparathyroidism, renal osteodystrophy and Paget’s disease will need systemic treatment as well.
Local benign conditions Fractures through benign cystlike lesions usually heal quite well and they should be allowed to do so before tackling the local lesion. Treatment is therefore the same as for simple fractures in the same area, although in some cases it will be necessary to take a biopsy before immobilizing the fracture. When the bone has healed, the tumour can be dealt with by curettage or local excision.
Primary malignant tumour The fracture may need splinting but this is merely a prelude to definitive treatment of the tumour, which by now will have spread to the surrounding soft tissues. The prognosis is almost always very poor.
Metastatic tumours Metastasis is a frequent cause of pathological fracture in older people. Breast cancer is the commonest source and the femur the commonest site. Nowadays cancer patients (even those with metastases) often live for several years and effective treatment of the fracture will vastly improve their quality of life.
Fracture of a long-bone shaft should be treated by internal fixation; if necessary the site is also packed with acrylic cement. Bear in mind that the implant will function as a load-bearing and not a load-sharing device; intramedullary nails are more suitable than plates and screws.
Fracture near a bone end can often be treated by excision and prosthetic replacement; this is especially true of femoral neck fractures.
Preoperatively, imaging studies should be performed to detect other bone lesions; these may be amenable to prophylactic fixation. Once the wound has healed, local irradiation should be applied to reduce the risk of progressive osteolysis.
Pathological compression fractures of the spine cause severe pain. This is due largely to spinal instability and treatment should include operative stabilization. If there are either clinical or imaging features of actual or threatened spinal cord or cauda equina compression, the segment should also be decompressed. Postoperative irradiation is given as usual.
With all types of metastatic lesion, the primary tumour should be investigated and treated as well.
---from 《Apley’s System of Orthopaedics and Fractures》P726-727
重点词汇整理：
underlying /ˌʌndərˈlaɪɪŋ/adj. 潜在的；根本的；在下面的；优先的v. 放在…的下面；为…的基础；优先于
properly immobilized妥善固定
osteomalacia, hyperparathyroidism, renal osteodystrophy骨软化，甲状旁腺功能亢进，肾性骨营养不良
tackle /ˈtækl/v. 应付，处理（难题或局面）；与某人交涉
curettage /ˌkjʊrɪˈtɑːʒ/n. [妇产] 刮除术，刮治术
Primary malignant tumour 原发性恶性肿瘤
prelude /ˈpreljuːd/n. 前奏；序幕；前奏曲vt. 成为…的序幕；演奏…作为前奏曲
definitive /dɪˈfɪnətɪv/adj. 最后的；最佳的；最权威的；（邮票）普通标准型的n. 普通邮票；限定词
prognosis /prɑːɡˈnoʊsɪs/n. [医] 预后；预知
vastly /ˈvæstli/adv. 非常，极其；极大地，广大地；深远地
acrylic cement骨水泥;丙烯酸骨水泥
acrylic/əˈkrɪlɪk/adj. 丙烯酸的
cement /sɪˈment/n. 水泥；接合剂；纽带；
Bear in mind 记住；考虑到
intramedullary nails 髓内钉/,intrə,me'dʌləri/adj. [解剖] 髓内的
prosthetic replacement;假体置换
prosthetic /prɑːsˈθetɪk/adj. 假体的;修复的;义肢的
prophylactic/ˌproʊfəˈlæktɪk/adj. 预防性的，预防疾病的
osteolysis. /,ɔsti'ɔlisis/n. [外科] 骨质溶解
spinal cord脊髓
cauda equina compression马尾神经压迫损害
cauda/'kaudə/n. [解剖][动] 尾；尾状物
equina神经
irradiation /ɪˌreɪdiˈeɪʃn/n. 照射；发光，放射
百度翻译：
治疗
骨折治疗的原则是一样的：减少，保持，锻炼。然而，方法的选择受骨骼状况的影响；潜在的病理性疾病可能需要自行治疗（见第9章）。
全身性骨疾病在大多数情况下（包括佩吉特病），骨骼骨折更容易，但只要骨折固定得当，它们就会愈合得很好。因此，内固定是可取的（对于Paget病几乎是必要的）。骨软化、甲状旁腺功能亢进、肾性骨营养不良和佩吉特病患者也需要全身治疗。
局部良性条件通过良性囊肿样病变骨折通常愈合得很好，在处理局部病变之前应该允许这样做。因此，治疗方法与同一区域的单纯骨折相同，尽管在某些情况下，固定骨折前需要进行活检。当骨头愈合后，肿瘤可以通过刮除或局部切除来治疗。
原发性恶性肿瘤骨折可能需要夹板固定，但这只是肿瘤最终治疗的前奏，到目前为止，肿瘤已经扩散到周围的软组织。预后几乎总是很差。
转移性肿瘤转移是老年人病理性骨折的常见原因。乳腺癌是最常见的来源，股骨是最常见的部位。现在癌症患者（甚至是转移患者）通常会活几年，有效的骨折治疗将大大提高他们的生活质量。
长骨干骨折应采用内固定治疗，必要时用丙烯酸水泥填塞。请记住，植入物将起到承重作用，而不是分担负荷的装置；髓内钉比钢板和螺钉更适合。
接近骨头末端的骨折通常可以通过切除和假体置换来治疗，尤其是股骨颈骨折。
术前应进行影像学检查，以发现其他骨损伤；这些骨损伤可预防性固定。伤口愈合后，应进行局部照射，以降低进行性骨溶解的风险。
病理性脊柱压缩性骨折引起剧烈疼痛。这主要是由于脊柱不稳，治疗应包括手术稳定。如果有临床或影像学特征的实际或威胁脊髓或马尾压迫，该节段也应减压。术后照常照射。
对于各种类型的转移性病变，原发性肿瘤也应进行调查和治疗。