骨科英文书籍精读（15）｜骨折牵引
CONTINUOUS TRACTION
Traction is applied to the limb distal to the fracture,so as to exert a continuous pull in the long axis of the bone, with a counterforce in the opposite direction(to prevent the patient being merely dragged along the bed). This is particularly useful for shaft fractures that are oblique or spiral and easily displaced by muscle contraction.
Traction cannot hold a fracture still; it can pull along bone straight and hold it out to length but to maintain accurate reduction is sometimes diffificult.Meanwhile the patient can move the joints and exercise the muscles.
Traction is safe enough, provided it is not excessive and care is taken when inserting the traction pin. The problem is speed: not because the fracture unites slowly (it does not) but because lower limb traction keeps the patient in hospital. Consequently, as soon as the fracture is ‘sticky’ (deformable but not displaceable), traction should be replaced by bracing, if this method is feasible. Traction includes:
· Traction by gravity – This applies only to upperlimb injuries. Thus, with a wrist sling the weight of the arm provides continuous traction to the humerus. For comfort and stability, especially with a transverse fracture, a U-slab of plaster may be bandaged on or, better, a removable plastic sleeve from the axilla to just above the elbow is held on with Velcro.
·Skin traction– Skin traction will sustain a pull of no more than 4 or 5 kg. Holland strapping or oneway-stretch Elastoplast is stuck to the shaved skin and held on with a bandage. The malleoli are protected by Gamgee tissue, and cords or tapes areused for traction.
· Skeletal traction – A stiff wire or pin is inserted –usually behind the tibial tubercle for hip, thigh and knee injuries, or through the calcaneum for tibial fractures – and cords tied to them for applying traction. Whether by skin or skeletal traction, the fracture is reduced and held in one of three ways: fifixed traction, balanced traction or a combination of the two.
Fixed traction
The pull is exerted against a fifixed point. The usual method is to tie the traction cords to the distal end of a Thomas’ splint and pull the leg down until the proximal,padded ring of the splint abuts firmly against the pelvis.
Balanced traction
Here the traction cords are guided over pulleys at the foot of the bed and loaded with weights; counter-traction is provided by the weight of the body when the foot of the bed is raised.
Combined traction
If a Thomas’ splint is used, the tapes are tied to the end of the splint and the entire splint is then suspended, as in balanced traction.
---from 《Apley’s System of Orthopaedics and Fractures》P696-697
重点词汇整理：
long axis 长轴
counterforce /'kaʊntɚ,fors/ n. 反作用力；反对势力；核子武器还击
oblique or spiral fracture斜形或螺旋形骨折
contraction /kənˈtrækʃn/n. 收缩，紧缩；缩写式；害病
traction /ˈtrækʃn/n. 牵引；牵引力
maintain accurate reduction 保持准确的复位
provided /prəˈvaɪdɪd/conj. 假如，倘若v. 提供，给予（provide 的过去式和过去分词）
Consequently, /ˈkɑːnsɪkwentli/adv. 因此；结果；所以
deformable /,di'fɔ:məbl/adj. 可变形的
deform /dɪˈfɔːrm/adj. 畸形的；丑陋的
vi. 变形；变畸形vt. 使变形；使成畸形
feasible./ˈfiːzəbl/adj. 可行的；可能的；可实行的
bracing,n. 支撑，支柱；背带
wrist sling 腕带
sling /slɪŋ/n. 吊索；投石器；抛掷
U-slab of plaster U形石膏
sleeve /sliːv/n. 套筒， 套管；袖子
axilla /æk'silə/n. [解剖] 腋窝，[解剖] 腋下；咯肢窝
Velcro魔术贴，尼龙搭扣
Elastoplast /i'læstəplɑ:st/n. 弹性绷带；（英）弹性黏膏
shave skin 备皮
tape . 胶带；磁带；带子；卷尺
stiff wire 硬线
tibial tubercle 胫骨结节
a Thomas’ splint 托马斯架
proximal, /ˈprɑːksɪməl/adj. 近端的；近源的；（牙齿）近侧的
padded ring of the splint abuts firmly against the pelvis.夹板的衬垫环紧靠在骨盆上
padded ring垫环 /'pædid/adj. 有装填垫料的
pulley /ˈpʊli/n. 滑轮；皮带轮；滑车
counter-traction对抗牵引
百度翻译：
持续牵引
牵引力作用于骨折远端的肢体，以在骨骼长轴上施加持续的拉力，反力作用于相反方向（以防止患者仅仅被拖到床上）。这对于斜角或螺旋形且容易因肌肉收缩而移位的轴断裂特别有用。
牵引不能使骨折保持静止，它可以沿着骨头直拉并保持到一定长度，但有时难以保持精确的复位，同时病人可以移动关节并锻炼肌肉。
牵引力足够安全，只要不过分，插入牵引销时要小心。问题是速度：不是因为骨折不愈合（不是），而是因为下肢牵引使病人住院。因此，只要骨折是“粘性的”（可变形但不可移位），如果这种方法可行，就应该用支撑代替牵引。牵引力包括：
·重力牵引-仅适用于上肢损伤。因此，用一个手腕吊带，手臂的重量提供持续的牵引肱骨。为了舒适和稳定，尤其是横向骨折，可以在U形石膏板上包扎，或者用尼龙搭扣固定腋窝至肘部上方的可拆卸塑料套管。
·皮肤牵引力-皮肤牵引力将维持不超过4或5公斤的拉力。Holland strapping或单向拉伸弹性塑料粘在剃光的皮肤上，并用绷带固定。踝关节由Gamgee组织保护，绳索或胶带用于牵引。
·骨骼牵引-一根硬钢丝或别针插入-通常在髋部、大腿和膝盖损伤的胫骨结节后面，或胫骨骨折的跟骨后面-和用于应用牵引的绳索。无论是皮肤牵引还是骨骼牵引，骨折都会减少，并通过以下三种方式之一保持：固定牵引、平衡牵引或两者的结合。
固定牵引力
对五个固定点施加拉力。通常的方法是将牵引索系在托马斯夹板的远端，然后将腿向下拉，直到夹板的近端、垫环与猫咪五次接触为止。
平衡牵引
在这里，牵引索被引导到床脚的滑轮上，并装载重物；当床脚抬起时，由身体重量提供反向牵引。
联合牵引
如果使用托马斯的夹板，带子被系在夹板的末端，然后整个夹板被悬挂，就像平衡牵引一样