骨科英文书籍精读（33）｜骨折早期并发症之感染
HAEMARTHROSIS
Fractures involving a joint may cause acute haemarthrosis. The joint is swollen and tense and the patient resists any attempt at moving it. The blood should be aspirated before dealing with the fracture.
INFECTION
Open fractures may become infected; closed fractures hardly ever do unless they are opened by operation. Post-traumatic wound infection is now the most common cause of chronic osteitis. The management
of early and late infection is summarized under the section Sequels to open fractures (page 710).
GAS GANGRENE
This terrifying condition is produced by clostridial infection (especially Clostridium welchii). These are anaerobic organisms that can survive and multiply only in tissues with low oxygen tension; the prime site for infection, therefore, is a dirty wound with dead muscle that has been closed without adequate debridement. Toxins produced by the organisms destroy the cell wall and rapidly lead to tissue necrosis, thus promoting the spread of the disease.
Clinical features appear within 24 hours of the injury: the patient complains of intense pain and swelling around the wound and a brownish discharge may be seen; gas formation is usually not very marked. There is little or no pyrexia but the pulse rate is increased and a characteristic smell becomes evident (once experienced this is never forgotten). Rapidly the patient becomes toxaemic and may lapse into coma and death.
It is essential to distinguish gas gangrene, which is characterized by myonecrosis, from anaerobic cellulitis, in which superficial gas formation is abundant but toxaemia usually slight. Failure to recognize the difference may lead to unnecessary amputation for the non-lethal cellulitis.
Prevention
Deep, penetrating wounds in muscular tissue are dangerous; they should be explored, all dead tissue should be completely excised and, if there is the slightest doubt about tissue viability, the wound should be left open. Unhappily there is no effective antitoxin against C. welchii.
Treatment
The key to life-saving treatment is early diagnosis. General measures, such as fluid replacement and intravenous antibiotics, are started immediately. Hyperbaric oxygen has been used as a means of limiting the spread of gangrene. However, the mainstay of treatment is prompt decompression of the wound and removal of all dead tissue. In advanced cases, amputation may be essential.
---from 《Apley’s System of Orthopaedics and Fractures》P714-715
重点词汇整理：
HAEMARTHROSIS关节血肿;关节积血
aspirate/'æspərət/n. 送气音；抽出物
adj. 送气音的vt. 送气发音；吸入
osteitis /,ɑstɪ'aɪtɪs/n. [外科] 骨炎
Sequel /ˈsiːkwəl/n. 续集；结局；继续；后果
GAS GANGRENE气性坏疽
clostridial infection 梭状芽孢杆菌感染
Clostridium welchii魏氏梭状芽孢杆菌
anaerobic /ˌænəˈroʊbɪk/adj. [微] 厌氧的，[微] 厌气的；没有气而能生活的
Toxins /tɑksɪnz/n. [毒物] 毒素，毒质；毒素类（toxin的复数）
Clinical features临床特征；临床表现
intense pain 剧烈疼痛；剧痛/ɪnˈtens/adj. 强烈的；紧张的；非常的；热情的
brownish discharge 褐色分泌物
pyrexia /paɪ'rɛksɪə/n. [临床] 发热；热病
lapse into coma and death.陷入昏迷和死亡。
lapse/læps/n. 小错；过失；行为失检
v. （时间）流逝；（合同）终止；背弃（宗教信仰）
myonecrosis, 肌坏死
anaerobic cellulitis,厌氧菌蜂窝织炎
/,sɛljʊ'laɪtɪs/n. [外科] 蜂窝组织炎
toxaemia /tɔk'si:miə/n. 毒血症
amputation/ˌæmpjuˈteɪʃn/n. 截肢；切断（术）
non-lethal cellulitis. 非致命蜂窝组织炎。
penetrating/ˈpenətreɪtɪŋ/v. 穿透；贯穿（penetrate的ing形式）adj. 渗透的；尖锐的；有洞察力的
penetrating wounds 穿透伤
completely excised完全切除/ɛk'saɪz/v. 切除；删除；收税，征税
tissue viability组织活力/ˌvaɪəˈbɪləti/n. 生存能力，发育能力；可行性
antitoxin /,æntɪ'tɑksɪn/n. 抗毒素；抗毒素血清
fluid replacement 补液
intravenous antibiotics静脉注射抗生素
Hyperbaric oxygen高压氧
mainstay /ˈmeɪnsteɪ/n. 支柱；中流砥柱；主要的依靠；主桅支索
prompt decompression 即使减压
百度翻译：
关节血肿
关节骨折可引起急性血液病。关节肿胀和紧张，病人抗拒任何移动它的企图。骨折治疗前应先抽血。
感染
开放性骨折可能会感染；闭合性骨折除非通过手术切开，否则很难感染。创伤后伤口感染是目前慢性骨炎最常见的病因。管理层
早期和晚期感染的总结见开放性骨折后遗症一节（第710页）。
气性坏疽
这种可怕的情况是由梭菌感染（特别是魏氏梭菌）引起的。这些是厌氧菌，只能在低氧张力的组织中存活和繁殖；因此，感染的主要部位是一个脏的伤口，肌肉坏死，在没有充分清创的情况下闭合。生物体产生的毒素破坏细胞壁，迅速导致组织坏死，从而促进疾病的传播。
伤后24小时内出现临床特征：病人抱怨伤口周围剧烈疼痛和肿胀，可见褐色分泌物；气体形成通常不太明显。有很少或没有发热，但脉搏加快，一个特征性的气味变得明显（一旦经历这是永远不会忘记）。病人很快就会中毒，并可能陷入昏迷和死亡。
必须区分以肌坏死为特征的气性坏疽和表面气体形成丰富但毒血症通常轻微的厌氧蜂窝织炎。未能认识到这一差异可能导致非致命性蜂窝织炎不必要的截肢。
预防
肌肉组织中的深层穿透性伤口是危险的；应进行探查，所有坏死组织应完全切除，如果对组织的生存能力有丝毫怀疑，则伤口应保持开放。不幸的是，没有有效的抗韦尔奇弧菌毒素。
治疗
早期诊断是抢救生命的关键。一般的措施，如液体置换和静脉注射抗生素，立即开始。高压氧已被用作限制坏疽扩散的手段。然而，主要的治疗方法是迅速减压和清除所有的死亡组织。在晚期病例中，截肢可能是必要的。