骨科英文书籍精读（165）｜手外伤（4）
Primary treatment
PREOPERATIVE CARE
The patient may need treatment for pain and shock. If the wound is contaminated, it should be rinsed with sterile crystalloid; antibiotics should be given as soon as possible. Prophylaxis against tetanus and gas gangrene may also be needed. The hand is lightly splinted and the wound is covered with an iodine-soaked dressing.
WOUND EXPLORATION
Under general or regional anaesthesia, the wound is cleaned and explored. A pneumatic tourniquet is essential unless there is a crush injury where muscle viability is in doubt. Skin is too precious to waste and only obviously dead skin should be excised. For adequate exposure the wound may need enlarging, but incisions must not cross a skin crease or an interdigital web. Through the enlarged wound, loose debris is picked out, dead muscle is excised and the tissues are thoroughly irrigated with isotonic crystalloid solution. A further assessment of the extent of the injury is then undertaken.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
sterile crystalloid无菌晶体液
sterile /ˈsterəl/adj. 不育的；无菌的；贫瘠的；不毛的；枯燥乏味的
crystalloid /ˈkrɪstlˌɔɪd/n. 晶体；[植] 类晶体adj. 结晶状的；透明的
Prophylaxis/ˌproʊfəˈlæksɪs/n. [医] 预防；预防法
tetanus/ˈtetnəs/n. [内科] 破伤风；强直
gas gangrene气性坏疽
gangrene /ˈɡæŋɡriːn/n. [外科] 坏疽
vt. 使生坏疽vi. 生坏疽；腐败
iodine /ˈaɪədaɪn/n. 碘；碘酒
soaked /soʊkt/v. 浸湿（soak的过去分词）adj. 湿透的，浸透的
dressing.敷料
pneumatic tourniquet充气止血带
pneumatic /nuːˈmætɪk/n. 气胎adj. 气动的；充气的；有气胎的
tourniquet /ˈtɜːrnəkət/n. [外科] 止血带；压脉器；压血带
precious /ˈpreʃəs/adj. 宝贵的；珍贵的；矫揉造作的
crease /kriːs/n. 折痕；皱褶；折缝vt. 弄皱；使起折痕vi. 起皱
interdigital web指蹼
debris/dəˈbriː/n. 碎片，残骸
isotonic crystalloid solution.等渗晶体溶液
extent/ɪkˈstent/n. 程度；范围；长度
百度翻译：
初级处理
术前护理
病人可能需要治疗疼痛和休克。如果伤口被污染，应使用无菌晶体冲洗；应尽快使用抗生素。可能还需要预防破伤风和毒气。手轻轻地用夹板固定，伤口上覆盖着浸有碘的敷料。
伤口探查
在全身麻醉或局部麻醉下，对伤口进行清洁和探查。一个气动止血带是必要的，除非有挤压伤的肌肉活力是怀疑的。皮肤太珍贵，不能浪费，只有明显的死皮才应该切除。为了充分暴露，伤口可能需要扩大，但切口不能穿过皮肤皱褶或胃间网。通过扩大的伤口，取出松散的碎片，切除坏死的肌肉，用等渗结晶溶液彻底冲洗组织。然后对损伤程度进行进一步评估。