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我们正在精读国外经典骨科书籍《Apley’s System of Orthopaedics and Fractures》，想要对于骨科英文形成系统认识，为以后无障碍阅读英文文献打下基础，请持续关注。
Mechanism of injury and pathological anatomy Most ligament injuries occur while the knee is bent, i.e. when the capsule and ligaments are relaxed and the femur is allowed to rotate on the tibia. The damaging force may be a straight thrust (e.g. a dashboard injury forcing the tibia backwards) or, more commonly, a combined rotation and thrust as in a football tackle. The medial structures are most often affected but if the injury involves a twist in addition to a valgus force, the ACL also may be damaged. This twisting force in a weightbearing knee often tears the medial meniscus, causing the well-recognized triad of MCL, ACL and medial meniscal injury described by O’Donoghue. A solitary MCL injury, if sufficiently severe, can be shown to cause the knee joint to ‘open’ on the medial side when the joint is flexed to 30 degrees a valgus stress is applied, but if this is still detectable when the knee is extended, then it is likely the expansions of the semimembranosus tendon, capsule and ACL are also damaged. Forces that push the tibia into varus will damage the lateral structures, but these forces are relatively uncommon; as with medial injuries, the cruciate ligaments are at risk if there is a twisting component, and a clinically detectable opening on varus stressing in an extended knee suggests that there is, in addition to a rupture of the LCL, capsular and cruciate damage. Cruciate ligament injuries occur in isolation or in combination with damage to other structures. The ACL is the more commonly affected. Solitary cruciate ligament injuries result in instability in the sagittal plane, i.e. the tibia can be pushed backwards or pulled forwards in relation to the femoral condyles. If there is accompanying damage to a collateral ligament or the capsule, then the direction of instability is often oblique and there may be a problem in controlling rotation. These oblique plane and rotatory instabilities are complex; in essence, one of the cruciate ligaments is ruptured and there is also laxity in one part of the capsule – this causes movement of the tibia on the femur, usually around an axis of the remaining intact capsule or other supporting ligament. Thus, in the more common anterolateral instability, where the ACL, lateral capsule and LCL are injured, the lateral plateau of the tibia can be made to sublux anteriorly when the tibia is rotated internally. If this is done with the knee fully extended whilst maintaining a valgus force, and the knee is then gradually flexed, a palpable reduction of this subluxation is felt at 20–30 degrees. This is the basis of the pivot shift test; it is thought the tibia rotates around the axis of an intact MCL. The common rotational instability patterns are summarized in Table 30.1, showing the likely ligaments involved and the clinical tests for assessment. ---from 《Apley’s System of Orthopaedics and Fractures》 重点词汇整理： tackle /ˈtækl/v. 应付，处理（难题或局面）（足球、曲棍球等）抢球； meniscus/məˈnɪskəs/n. [解剖] 半月板；弯月面；新月形物 the well-recognized triad of MCL, ACL and medial meniscal injury 公认的MCL、前交叉韧带和内侧半月板损伤三联征 the well-recognized triad 公认的三联征 /ˈtraɪæd/n. 三和音；三个一组 isolation /ˌaɪsəˈleɪʃn/n. 隔离；孤立；[电] 绝缘；[化学] 离析 Solitary /ˈsɑːləteri/n. 独居者；隐士adj. 孤独的；独居的 isolate /ˈaɪsəleɪt/adj. 孤独的，孤立的vt. （使）隔离，孤立； sagittal plane矢状平面 /ˈsædʒətəl/adj. 矢状的，前后向的 i.e. abbr. 即，也就是 (id est) /ɪd est/（拉丁）那就是（常略作i.e.） oblique plane斜面 in essence, 本质上；其实；大体上 axis /ˈæksɪs/n. 轴；轴线；轴心国 the lateral plateau of the tibia 胫骨的外侧平台 plateau/plæˈtoʊ/n. 高原；稳定水平；托盘；平顶女帽vi. 达到平衡；达到稳定时期 rotated internally内旋 palpable /ˈpælpəbl/adj. 明显的；可感知的；易觉察的 the clinical tests for assessment用于评估的临床测试 百度翻译： 损伤机制与病理解剖 大多数韧带损伤发生在膝关节弯曲时，即当关节囊和韧带放松，允许股骨在胫骨上旋转时。老化力可能是直线推力（如仪表板损伤迫使胫骨向后），或者更常见的是旋转和推力的组合，如足球铲球。内侧结构最常受到影响，但如果损伤除了val gus力外还包括扭转，ACL也可能受到损伤。负重膝关节的这种扭转力经常撕裂内侧半月板，导致O'Donoghue所描述的公认的MCL、ACL和内侧半月板损伤三位一体。单独的MCL损伤，如果足够严重，当关节弯曲到30度时，可以显示为膝关节内侧“开放”，并施加外翻应力，但如果在伸膝时仍能检测到，则半膜肌腱、囊膜和ACL的扩张也可能受到损伤。 将胫骨推入内翻的力会损伤外侧结构，但这些力相对不常见；与内侧损伤一样，如果存在扭转成分，交叉韧带也有风险，临床上可检测到的内翻开口在伸直的膝盖上产生应力表明，除了LCL断裂外，关节囊和十字韧带损伤。 交叉韧带损伤单独发生或与其他结构损伤合并发生。ACL是最常见的病变。单交叉韧带损伤导致矢状面不稳定，即胫骨相对于股骨髁可以向后推或向前拉。如果伴有副韧带或关节囊的损伤，那么不稳定的方向通常是倾斜的，在控制旋转方面可能有问题。这些斜面和旋转不稳定是复杂的；本质上，一条交叉韧带断裂，关节囊的一部分松弛——这导致胫骨在股骨上移动，通常围绕剩余完整关节囊或其他支撑韧带的轴。因此，在更常见的前外侧不稳定中，前交叉韧带、外侧关节囊和LCL受到损伤，当胫骨内旋时，胫骨外侧平台可以向前下滑脱。如果在保持外翻力的同时使膝盖完全伸展，然后膝盖逐渐弯曲，在20-30度时可以感觉到半脱位明显减少。 这是轴心移位试验的基础；据认为胫骨绕完整MCL的轴旋转。表30.1总结了常见的旋转不稳定性模式，显示了可能涉及的韧带和评估的临床试验。 |
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