骨科英文书籍精读（234）｜股骨颈骨折的诊断
中国十大名师之一赖世雄老师说过，学习英语没有捷径，少就是多，快就是慢。不要以量取胜，把一个音标、一个单词、一段对话、一篇文章彻底搞透，慢慢积累，你会发现，你并不比每天走马观花的输入大量英文学的差。
Diagnosis
There are four situations in which a femoral neck fracture may be missed, sometimes with dire consequences.
· Stress fractures
The elderly patient with unexplained pain in the hip should be considered to have a stress fracture until proved otherwise. A similar cautionary note is raised for young athletes who do regular impact-loading sports and military personnel on marching routines. The x-ray is usually normal but a bone scan, or better still an MRI, will show the lesion (Figure 29.6).
· Undisplaced fractures
Impacted fractures may be extremely difficult to discern on plain x-ray. If there is a fracture it will show up on MRI or a bone scan after a few days.
· Painless fractures
A bed-ridden patient may develop a ‘silent’ fracture. Even a fit patient occasionally walks about without pain if the fracture is impacted. If the context suggests an injury, investigate –whether the patient complains or not.
· Multiple fractures
The patient with a femoral shaft fracture may also have a hip fracture, which is easily missed unless the pelvis is x-rayed.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
dire /ˈdaɪər/adj. 可怕的；悲惨的；极端的
cautionary note警示说明
march /mɑːrtʃ/vi. （坚定地向某地）前进；行军，进军；游行示威；进展，进行vt. 使前进；使行军n. 行进，前进；行军；游行示威；进行曲
discern /dɪˈsɜːrn/vt. 觉察出；识别；了解；隐约看见vi. 辨别
百度翻译：
诊断
有四种情况下股骨颈骨折可能漏诊，有时后果严重。
·应力断裂
老年患者髋关节疼痛原因不明，应考虑有应力性骨折，除非另有证明。对于那些经常进行冲击负荷运动的年轻运动员和军事人员，也提出了类似的警告。x光通常是正常的，但是骨扫描，或者更好的是核磁共振成像，可以显示病变（图29.6）。
·片状骨折
埋伏骨折在平片上很难辨认。如果有骨折，几天后就会出现在核磁共振成像或骨扫描上。
·无痛性骨折
卧床不起的病人可能会发生“无声”骨折。如果骨折受到撞击，即使是健康的病人偶尔也会无痛行走。如果情况表明受伤，调查患者是否抱怨。
·多处骨折
股骨干骨折的患者也可能有髋部骨折，除非对骨盆进行x光检查，否则很容易漏诊。