骨科英文书籍精读（268）｜股骨干骨折的外支架治疗
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External fixation
The main indications for external fixation are (1) treatment of severe open injuries; (2) management of patients with multiple injuries where there is a need to reduce operating time and prevent the ‘second hit’; and (3) the need to deal with severe bone loss by the technique of bone transport. External fixation is also useful for (4) treating femoral fractures in adolescents (Figure 29.26).
Like closed intramedullary nailing, it has the advantage of not exposing the fracture site and small amounts of axial movement can be applied to the bone by allowing a telescoping action in the fixator body (with some designs of external fixator). As the callus increases in volume and quality, the fixator can be adjusted to increase stress transfer to the fracture site, thus promoting quicker consolidation. However, there are still problems with pin-site infection, pin loosening and (if the half-pins are applied close to joints) limitation of movement due to interference with sliding structures.
The patient is allowed up as soon as he or she is comfortable and knee movement exercises are encouraged to prevent tethering by the half pins. Partial weightbearing is usually possible immediately but this will depend on the x-ray appearance of callus – this may take some time (more than 6 weeks) if the fixator is a rigid device. Most femoral shaft fractures will unite in under 5 months but some take longer if the fracture is badly comminuted or contact between fracture ends is poor.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
reduce operating time减少操作时间
bone transport骨搬移
axial movement 轴向移动
telescope /ˈtelɪskoʊp/n. 望远镜v. 叠套缩短；精简，压缩；（车）相撞而嵌进
telescoping action 可伸缩的动作
pin-site infection钉道感染
there are still problems with pin-site infection, pin loosening and limitation of movement due to interference with sliding structures.仍然存在着钉道感染、钉松动以及由于滑动装置的干扰而限制运动的问题。
百度翻译：
外固定
外固定架的主要适应症是：（1）治疗严重开放性损伤；（2）管理多发伤患者，需要减少手术时间和防止“第二次撞击”；（3）需要通过骨运输技术处理严重的骨丢失。外固定架在青少年股骨骨折的治疗中也很有用（图29.26）。
与闭合髓内钉一样，它的优点是不暴露骨折部位，通过在固定器体内进行伸缩作用，可以对骨进行少量轴向移动（有一些外固定器的设计）。随着骨痂体积和质量的增加，可以调整固定器以增加应力转移到骨折部位，从而促进更快的愈合。然而，由于与滑动结构的干扰，仍然存在销位置感染、销松动和（如果半销靠近接头）移动限制的问题。
一旦病人感到舒服，就允许他或她起来，并鼓励进行膝关节运动训练，以防止被半销栓住。部分负重通常可以立即进行，但这将取决于骨痂的x光外观-如果固定器是刚性装置，这可能需要一些时间（超过6周）。大多数股骨干骨折在5个月内愈合，但如果骨折严重粉碎或骨折端接触不良，则需要更长的时间。