骨科英文书籍精读（171）｜手外伤（10）
DRESSING AND SPLINTAGE
The wound is covered with a single layer of paraffin gauze and ample wool roll. A light plaster slab holds the wrist and hand in the position of safety (wrist extended, metacarpo-phalangeal joints flexed to 90 degrees, interphalangeal joints straight, thumb abducted). This is the position in which the metacarpo-phalangeal and interphalangeal ligaments are fully stretched and fibrosis therefore least likely to cause contractures. Failure to appreciate this point is the commonest cause of irrecoverable stiffness after injury (see Fig 16.26).
This position is modified in two circumstances. (1) After primary flexor tendon suture, the wrist is held with a dorsal splint in about 20 degrees of flexion to take tension off the repair (too much wrist flexion
invites wrist stiffness and carpal tunnel symptoms) but the interphalangeal joints must remain straight. There should be minimal restriction at the front of the fingers, otherwise the resistance can precipitate rupture of the tendon. (2) After extensor tendon repair, the
metacarpo-phalangeal joints are flexed to only about 30 degrees so that there is less tension on the repair; the wrist is extended to 30 degrees and the interphalangeal joints remain straight.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
layer /ˈleɪər/n. 层，层次
paraffin /ˈpærəfɪn/n. 石蜡；[有化] 链烷烃；硬石蜡vt. 用石蜡处理；涂石蜡于…
gauze /ɡɔːz/n. 纱布；薄纱；薄雾
fibrosis /faɪˈbroʊsɪs/n. [医] 纤维化，[病理] 纤维变性
contracture /kənˈtræktʃər/n. [医] 挛缩
appreciate美 /əˈpriːʃieɪt/vi. 增值；涨价vt. 欣赏；感激；领会；鉴别
dorsal /ˈdɔːrsl/adj. （鱼或动物）背部的
precipitate /prɪˈsɪpɪteɪt/v. 使（坏事等）突然发生；使突然陷入（某种状态）；使沉淀；猛抛，猛地落下；冷凝成为雨或雪等adj. 鲁莽的，仓促的；突如其来的；猛地落下的n. 沉淀物
百度翻译：
敷料和夹板固定
伤口上覆盖着一层石蜡纱布和充足的羊毛卷。一块轻石膏板将手腕和手保持在安全位置（手腕伸直，掌骨指骨关节弯曲90度，指间关节伸直，拇指外展）。这是掌指骨和指间韧带完全伸展的位置，因此纤维化最不可能引起挛缩。未能意识到这一点是造成受伤后无法恢复僵硬的最常见原因（见图16.26）。
这一立场在两种情况下被修改。（1） 初级屈肌腱缝合后，用背夹板固定手腕约20度的屈曲，以消除修复时的张力（手腕过度弯曲引起腕关节僵硬和腕管症状），但指间关节必须保持伸直。在鳍条前部应该有最小限度的限制，否则阻力会导致肌腱断裂。（2） 伸肌腱修复后掌骨指骨关节仅弯曲约30度，因此修复时张力较小；手腕伸展至30度，指间关节保持笔直。