骨科英文书籍精读（54）｜关节损伤（1）
INJURIES TO JOINTS
Joints are usually injured by twisting or tilting forces that stretch the ligaments and capsule. If the force is great enough the ligaments may tear, or the bone to which they are attached may be pulled apart. The
articular cartilage, too, may be damaged if the joint surfaces are compressed or if there is a fracture into the joint.
As a general principle, forceful angulation will tear the ligaments rather than crush the bone, but in older people with porotic bone the ligaments may hold and the bone on the opposite side of the joint is crushed instead, while in children there may be a fracture-separation of the physis.
Sprains, strains and ruptures
There is much confusion about the use of the terms ‘sprain’, ‘strain’ and ‘rupture’. Strictly speaking, a sprain is any painful wrenching (twisting or pulling) movement of a joint, but the term is generally reserved for joint injuries less severe than actual tearing of the capsule or ligaments. Strain is a physical effect of stress, in this case tensile stress associated with some stretching of the ligaments; in colloquial usage, ‘strained ligament’ is often meant to denote an injury somewhat more severe than a ‘sprain’, which possibly involves tearing of some fibres. If the stretching or twisting force is severe enough, the ligament may be strained to the point of complete rupture.
STRAINED LIGAMENT
Only some of the fibres in the ligament are torn and the joint remains stable. The injury is one in which the joint is momentarily twisted or bent into an abnormal position. The joint is painful and swollen and the tissues may be bruised. Tenderness is localized to the injured ligament and tensing the tissues on that side causes a sharp increase in pain.
Treatment
The joint should be firmly strapped and rested until the acute pain subsides. Thereafter, active movements are encouraged, and exercises practised to strengthen the muscles.
---from 《Apley’s System of Orthopaedics and Fractures》P730
重点词汇整理：
tilting /tɪlt/n. 倾卸台v. 使倾斜（tilt的ing形式）
capsule/ˈkæpsl,ˈkæpsuːl/n.关节腔；胶囊；蒴果；太空舱；小容器adj. 压缩的；概要的vt. 压缩；简述
porotic bone疏松骨 /pə'rɔtik/n. 促骨痂生长药adj. 多孔性的；骨质疏松的
confusion /kənˈfjuːʒn/n. 混淆，混乱；困惑
Sprains, strains and ruptures扭伤，拉伤和破裂
wrenching /'rentʃiŋ/adj. 极为痛苦的，极为难受的v. 猛扭；扭伤；歪曲；用版钳拧（wrench 的现在分词形式）
tensile stress张应力；拉张应力
colloquial usage, 惯用语/kəˈloʊkwiəl/
adj. 白话的；通俗的；口语体的
denote /dɪˈnoʊt/vt. 表示，指示
bruised. /bruːzd/adj. 青肿的；瘀紫的v. 擦伤（bruise的过去式）
strapped /stræpt/v. 用带子系（strap 的过去式和过去分词）adj. 缺钱的，手头拮据的
subside /səbˈsaɪd/vi. 平息；减弱；沉淀；坐下
谷歌翻译：
关节损伤
关节通常是由于拉伸韧带和关节囊的扭转力或倾斜力造成的。如果力量足
够大，韧带可能会撕裂，或者它们连接的骨头可能会被撕裂。如果关节表面受压或关节内有骨折，关节软骨也可能受损。
一般说来，强力夹角会撕裂韧带而不是挤压骨头，但在患有多孔性骨病的老年人中，韧带可能会固定，而关节另一侧的骨头会被挤压，而在儿童中，可能会发生骨骺分离骨折。
扭伤、拉伤和破裂
“扭伤”、“拉伤”和“破裂”这些术语的用法有很多混淆之处。严格地说，扭伤是指关节的任何痛苦的扭动(扭动或拉动)，但该术语通常用于关节损伤，其严重程度低于关节囊或韧带的实际撕裂。应变是一种应力的物理效应，在这种情况下，与韧带的一些拉伸有关的拉应力；在口语用法中，‘张力韧带’通常表示比‘扭伤’更严重的损伤，可能包括撕裂一些纤维。如果伸展或扭转力足够大，韧带可能会拉伤到完全断裂的程度。
韧带拉伤
只有韧带中的一些纤维被撕裂，关节保持稳定。损伤是指关节瞬间扭曲或弯曲到不正常的位置。关节疼痛和肿胀，组织可能有瘀伤。压痛局限在受伤的韧带上，紧绷那一侧的组织会引起剧烈的疼痛。
治疗
关节应该牢固地捆扎和休息，直到急性疼痛消退。此后，鼓励积极的运动，并进行锻炼以增强肌肉力量。