骨科英文书籍精读（13）｜骨折闭合复位
CLOSED REDUCTION
Under appropriate anaesthesia and muscle relaxation, the fracture is reduced by a three-fold manoeuvre: (1) the distal part of the limb is pulled in the line of the bone; (2) as the fragments disengage, they are repositioned (by reversing the original direction of force if this can be deduced) and (3) alignment is adjusted in each plane. This is most effective when the periosteum and muscles on one side of the fracture remain intact; the soft-tissue strap prevents over-reduction Principles of fractures and stabilizes the fracture after it has been reduced (Charnley 1961).
Some fractures are difficult to reduce by manipulation because of powerful muscle pull and may need prolonged traction. Skeletal or skin traction for several days allows for soft-tissue tension to decrease and a better alignment to be obtained; this practice is helpful for femoral and tibial shaft fractures and even supracondylar humeral fractures in children.
In general, closed reduction is used for all minimally displaced fractures, for most fractures in children and for fractures that are not unstable after reduction and can be held in some form of splint or cast. Unstable fractures can also be reduced using closed methods prior to stabilization with internal or external fixation. This avoids direct manipulation of the fracture site by open reduction, which damages the local blood supply and may lead to slower healing times; increasingly, surgeons resort to reduction manoeuvres that avoid fracture-site exposure, even when the aim is some form of internal or external fixation. Traction, which reduces fracture fragments through ligamentotaxis (ligament pull), can usually be applied by using a fracture table or bone distractor.
---from 《Apley’s System of Orthopaedics and Fractures》P687-688
重点词汇整理：
a three-fold manoeuvre 3重手法
manoeuvre 熟练动作；（尤指以欺骗为目的）策略，手段；欺诈性操作；军事演习（等于 maneuver）v. （使谨慎或熟练地）移动；操控，使花招；诱使，诱导
disengage使脱离；解开；解除vi. 脱出；松开
plane 飞机；平面；程度，水平
periosteum [解剖] 骨膜
the soft-tissue strap 软组织带
strap 带子，皮带
manipulation /məˌnɪpjuˈleɪʃn/n. 操纵；操作；处理；篡改
prolonged traction长时间牵引
Skeletal or skin traction骨骼或皮肤牵引
soft-tissue tension 软组织张力
supracondylar humeral fractures 肱骨髁上骨折
supracondylar髁上的
splint or cast 夹板或石膏
Unstable fractures can also be reduced using closed methods prior to stabilization with internal or external fixation.不稳定骨折也可以在采用内固定或外固定前用闭合方法复位。
increasingly, surgeons resort to reduction manoeuvres that avoid fracture-site exposure, even when the aim is some form of internal or external fixation. 越来越多的外科医生采用减少骨折部位暴露的手法，即使其目的是进行某种形式的内固定或外固定。
ligamentotaxis 韧带趋向性（拉韧带）
bone distractor.骨牵开器
百度翻译：
闭合复位
在适当的麻醉和肌肉放松下，骨折通过三重动作复位：（1）将肢体的远端拉入骨线中；（2）当碎片分离时，它们被复位（如果可以推断的话，通过改变力的原始方向）和（3）在每个平面上调整对中。当骨折周围和一侧肌肉保持完整时，这是最有效的；软组织带防止骨折过度复位，并在骨折复位后稳定骨折（Charnley 1961）。
由于强力的肌肉牵引，一些骨折很难通过手法复位，可能需要长时间的牵引。连续几天的骨骼或皮肤牵引可使软组织张力降低并获得更好的对齐；这种做法有助于治疗儿童股骨干和胫骨骨干骨折，甚至肱骨髁上骨折。
一般来说，闭合复位适用于所有微小移位骨折，大多数儿童骨折和复位后不稳定的骨折，可以用夹板或石膏固定。不稳定骨折也可以在内固定或外固定前用闭合方法复位。这就避免了切开复位对骨折部位的直接操作，这会损害局部血液供应，并可能导致愈合时间减慢；外科医生越来越多地采用复位操作来避免骨折部位暴露，即使目标是某种形式的内固定或外固定。牵引，通过韧带旋转减少骨折碎片，通常可以使用骨折台或骨牵引器。