骨科英文书籍精读（292）｜股骨远端骨折的并发症
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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Complications
EARLY
Arterial damage
There is a small but definite risk of arterial damage and distal ischaemia. Careful assessment of the leg and peripheral pulses is essential, even if the x-ray shows only minimal displacement.
LATE
Joint stiffness
Knee stiffness – probably due to scarring from the injury and the operation – is almost inevitable. A long period of exercise is needed in all cases, and even then full movement is rarely regained. For marked stiffness, arthroscopic division of adhesions in the joint or even a quadricepsplasty may be needed.
Malunion
Internal fixation of these fractures is difficult and malunion – usually varus and recurvatum – is not uncommon. Corrective osteotomy may be needed for patients who are still physically active.
Non-union
Modern surgical techniques of internal fixation recognize the importance of minimizing damage to the soft tissues around the fracture; where possible, only those parts that are essential for fracture
reduction are exposed. The knee joint may need to be opened for reduction of articular fragments but the metaphyseal area is left untouched in order to preserve its vitality. If these precautions are taken, nonunion is unlikely. If non-union does occur, autogenous bone grafts and a revision of internal fixation will be needed – particularly if there are signs that the fixation is working loose or has failed.
Knee stiffness is another threat. Unless great care is exercised during mobilization, the ultimate range of movement at the knee may be less than that at the fracture!
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
peripheral /pəˈrɪfərəl/adj. 外围的；次要的；（神经）末梢区域的n. 外部设备
peripheral pulses周围脉搏
inevitable /ɪnˈevɪtəbl/adj. 必然的，不可避免的
arthroscopic 关节镜
Internal fixation of these fractures is difficult and malunion – usually varus and recurvatum – is not uncommon.
这些骨折的内固定很困难，畸形愈合——通常是内翻和反翻——并不少见。
physically active体力(体育)活动
vitality /vaɪˈtæləti/n. 活力，生气；生命力，生动性
autogenous bone自体骨
/ɔˈtɑːdʒənəs/adj. 自生的；自发的
ultimate range最大距离
/ˈʌltɪmət/n. 终极；根本；基本原则adj. 最终的；极限的；根本的
百度翻译：
早期并发症
动脉损伤
动脉损伤和远端缺血的风险很小但很明确。仔细评估腿部和外周脉搏是必要的，即使x光片显示位移很小。
晚期并发症
关节僵硬
膝盖僵硬——可能是由于受伤和手术留下的疤痕——几乎是不可避免的。所有情况下都需要长时间的锻炼，即使这样，也很少能恢复完全的运动。对于明显的僵硬，关节镜下分离关节粘连甚至股四头肌可能是必要的。
畸形愈合
内固定这些骨折是困难的，畸形愈合-通常是内翻和后仰-并不少见。对于仍在进行体力活动的患者，可能需要进行矫正性截骨术。
不愈合
现代外科内固定技术认识到尽可能减少骨折周围软组织损伤的重要性；在可能的情况下，仅限于骨折所必需的部位
减少暴露。可能需要打开膝关节以减少关节碎片，但干骺端区域保持不变，以保持其活力。如果采取这些预防措施，则不太可能发生不结合。如果不愈合确实发生，自体骨移植和内固定的修订将是必要的-特别是如果有迹象表明，固定工作松散或已失败。
膝盖僵硬是另一个威胁。除非在活动过程中非常小心，否则膝关节的最终活动范围可能小于骨折处的活动范围！