骨科英文书籍精读（42）｜骨折晚期并发症之肌肉挛缩
MUSCLE CONTRACTURE
Following arterial injury or compartment syndrome, the patient may develop ischaemic contractures of the affected muscles (Volkmann’s ischaemic contracture). Nerves injured by ischaemia sometimes recover, at least partially; thus the patient presents with deformity and stiffness, but numbness is inconstant. The sites most commonly affected are the forearm and hand, leg and foot.
In a severe case affecting the forearm, there will be wasting of the forearm and hand, and clawing of the fingers. If the wrist is passively flexed, the patient can extend the fingers, showing that the deformity is largely due to contracture of the forearm muscles. Detachment of the flexors at their origin and along the interosseous membrane in the forearm may improve the deformity, but function is no better if sensation and active movement are not restored. A pedicle nerve graft, using the proximal segments of the median and ulnar nerves may restore protective sensation in the hand, and tendon transfers (wrist extensors to finger and thumb flexors) will allow active grasp. In less severe cases, median nerve sensibility may be quite good and, with appropriate tendon releases and transfers, the patient regains a considerable degree of function.
Ischaemia of the hand may follow forearm injuries, or swelling of the fingers associated with a tight forearm bandage or plaster. The intrinsic hand muscles fibrose and shorten, pulling the fingers into flexion at the metacarpophalangeal joints, but the interphalangeal joints remain straight. The thumb is adducted across the palm (Bunnell’s ‘intrinsic-plus’ position).
Ischaemia of the calf muscles may follow injuries or operations involving the popliteal artery or its divisions. This is more common than is usually supposed. The symptoms, signs and subsequent contracture are similar to those following ischaemia of the forearm. One of the causes of late claw-toe deformity is an undiagnosed compartment syndrome.
---from 《Apley’s System of Orthopaedics and Fractures》P721
重点词汇整理：
muscle contracture肌肉挛缩
inconstant /ɪnˈkɑːnstənt/adj. 变化无常的；易变的；多变的
clawing of the fingers 爪形手
passively flexed被动弯曲，
interosseous membrane 前臂骨间膜
/,intər'ɔsiəs/adj. 骨间的；小腿骨间的；前臂骨间的
/ˈmembreɪn/n. 膜；薄膜
active movement主动活动
restored/ri'stɔ:d/v. 修复（restore的过去式）；恢复健康adj. 精力充沛的；精力恢复的
pedicle nerve graft,椎弓根神经移植
grasp /ɡræsp/v. 抓牢，握紧；试图抓住；理解，领悟；毫不犹豫地抓住（机会）n. 抓，握；理解，领会；力所能及，把握；权力，控制
regain/rɪˈɡeɪn/n. 收复；取回vt. 恢复；重新获得；收回vi. 上涨
intrinsic hand muscles手内在肌
fibrose形成纤维性组织
metacarpophalangeal joints掌指关节
interphalangeal joints指间关节
adduct /'ædʌkt/n. [化学] 加合物vt. 使内收
calf muscles腓肠肌群；小腿后肌
/kæf/n. [解剖] 腓肠，小腿；小牛；小牛皮
popliteal artery 腘动脉
/pɔp'litiəl, ,pɔpli'ti-/adj. 腘的，腿弯部的
This is more common than is usually supposed. The symptoms, signs and subsequent contracture are similar to those following ischaemia of the forearm.这种情况比人们通常想象的更为常见。症状、体征和随后的挛缩类似于那些随之而来的前臂缺血。
百度翻译：
肌肉挛缩
动脉损伤或室间隔综合征后，患者可能出现受影响肌肉的缺血挛缩（沃尔克曼缺血挛缩）。因缺血而受伤的神经有时会恢复，至少部分恢复；因此病人会出现畸形和僵硬，但麻木是不稳定的。最常受影响的部位是前臂和手、腿和脚。
在严重影响前臂的情况下，前臂和手会消瘦，手指会被抓。如果手腕被动弯曲，患者可以伸出手指，说明畸形主要是由于前臂肌肉挛缩所致。屈肌在其起点和前臂骨间膜的分离可以改善畸形，但如果感觉和主动运动不恢复，功能就不好。利用正中神经和尺神经近端节段的带蒂神经移植可以恢复手部的保护性感觉，肌腱转移（手腕伸肌到手指和拇指屈肌）将允许主动抓握。在不太严重的情况下，正中神经的敏感性可能相当好，适当的肌腱松解和转移，患者可以恢复相当程度的功能。
手部缺血可能是前臂损伤，或手指肿胀与前臂绷带或石膏绷带紧密相关。手的固有肌肉纤维化并变短，手指在掌指关节处弯曲，但指间关节保持笔直。拇指在手掌上内收（邦内尔的“内在加”位置）。
小腿肌肉的缺血可能发生在损伤或涉及腘动脉或其分支的手术之后。这比通常想象的要普遍。症状、体征和随后的挛缩与前臂缺血后的症状相似。晚期爪趾畸形的原因之一是未确诊的筋膜室综合征。