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POSTERIOR DISLOCATION Mechanism of injury This is a posterior dislocation, usually occurring in a road accident when someone seated in a truck or car is thrown forward, striking the knee against the dashboard. The femur is thrust upwards and the femoral head is forced out of its socket; often a piece of bone at the back of the acetabulum (usually the posterior wall) is sheared off, making it a fracture-dislocation. Seat-belt restraints can reduce the number of posterior hip dislocations. Clinical features In a straightforward case the diagnosis is easy; the leg is short and lies adducted, internally rotated and slightly flexed. However, if one of the long bones is fractured – usually the femur – the injury can easily be missed as the limb can adopt almost any position. The golden rule is to x-ray the pelvis in every case of severe injury and, with femoral fractures, to insist on an x-ray that includes both the hip and knee. The lower limb should be examined for signs of sciatic nerve injury (Figure 29.1). ---from 《Apley’s System of Orthopaedics and Fractures》 重点词汇整理： dashboard /ˈdæʃbɔːrd/n. 汽车等的仪表板；马车等前部的挡泥板 shear /ʃɪr/v. 剪（羊或其他动物的）毛；剪（头发）；（受剪切力作用而）断裂 adduct/ˈædʌkt; əˈdʌkt/vt. 使内收 internally rotated and slightly flexed.内旋和轻微弯曲。 百度翻译： 后脱位 损伤机制 这是一种后脱位，通常发生在交通事故中，当坐在卡车或汽车上的人被向前抛出时，膝盖撞到仪表板上。股骨被向上推，股骨头被推出其窝；通常髋臼后面（通常是后壁）的一块骨头被剪断，使其成为骨折的位置。安全带约束可以减少髋关节后脱位的数量。 临床特征 在直截了当的病例中，诊断很容易；腿短，内收，内旋，轻微弯曲。然而，如果其中一根长骨骨折——通常是股骨骨折——由于四肢几乎可以采取任何姿势，所以很容易就漏掉了。金科玉律是在每一例严重损伤的情况下都要对骨盆进行x光检查，对于股骨骨折，坚持要进行包括髋关节和膝关节在内的x光检查。下肢应检查坐骨神经损伤的迹象（图29.1）。 |
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