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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。
Early complications VASCULAR INJURY Fractures of the proximal half of the tibia may damage the popliteal artery. This is an emergency of the first order, requiring exploration and repair. Damage to one of the two major tibial vessels may also occur and go unnoticed if there is no critical ischaemia. COMPARTMENT SYNDROME Tibial fractures – both open and closed – are among the commonest causes of compartment syndrome in the leg. The combination of tissue oedema and bleeding (oozing) causes swelling in the muscle compartments and this may precipitate ischaemia. Additional risk factors are proximal tibial fractures, severe crush injury, a long ischaemic period before revascularization (in type IIIC open fractures), a long delay to treatment, haemorrhagic shock, difficult and prolonged operation and a fracture fixed in distraction. The diagnosis is usually suspected on clinical grounds. Warning symptoms are increasing pain, a feeling of tightness or 'bursting’ in the leg and numbness in the leg or foot. These complaints should always be taken seriously and followed by careful and repeated examination for pain provoked by muscle stretching and loss of sensibility and/or muscle strength. Heightened awareness is all! The diagnosis can be confirmed by measuring the compartment pressures in the leg. Indeed, so important is the need for early diagnosis that some surgeons advocate the use of continuous compartment pressure monitoring for all tibial fractures (McQueen et al., 1996). This deals admirably with patients who are unconscious or uncooperative, and those with multiple injuries. It also serves as an 'early warning system’ in less problematic cases. A split-tip 20-gauge catheter is introduced into the anterior compartment of the leg and the pressure is measured close to the level of the fracture (Heckman et al., 1994). A differential pressure (ΔP) – the difference between diastolic pressure and compartment pressure – of less than 30 mmHg (4.00 kPA) is regarded as critical and an indication for compartment decompression. Ideally the pressure should be measured in all four compartments but this is often impractical; however, if the clinical features suggest a compartment syndrome and the anterior compartment pressure is normal or borderline, pressures should be measured in the other compartments. ---from 《Apley’s System of Orthopaedics and Fractures》 重点词汇整理： popliteal artery.腘动脉 critical ischaemia重症缺血性疾病 oedema /ɪˈdiːmə/n. [病理] 水肿；[植] 瘤腺体 oozing /ˈuːzɪŋ/v. 渗出（ooze的ing形式）；渗透 precipitate /prɪˈsɪpɪteɪt/v. 使（坏事等）突然发生；使突然陷入（某种状态）；使沉淀；猛抛，猛地落下；冷凝成为雨或雪等adj. 鲁莽的，仓促的；突如其来的；猛地落下的n. 沉淀物 revascularization /ri:,væskjulərai'zeiʃən, -ri'z-/n. 血管的再形成，血管再生;血管重建 haemorrhagic shock失血性休克 The diagnosis is usually suspected on clinical grounds.这种诊断通常是基于临床原因而怀疑的。 grounds /ɡraʊndz/n. 根据，理由（ground的复数形式）；基础；地面；运动场地 provoke /prəˈvoʊk/vt. 驱使；激怒；煽动；惹起 muscle stretching 肌肉牵张运动 Heightened awareness is all! 提高意识就是一切! This deals admirably with patients who are unconscious or uncooperative这种方法适用于昏迷或不合作的病人 admirably /ˈædmərəbli/adv. 美好地，极好地；令人钦佩地 A differential pressure (ΔP) – the difference between diastolic pressure and compartment pressure 压差(ΔP) -舒张压和室压之间的差 diastolic /ˌdaɪəˈstɑːlɪk/adj. 心脏舒张的 impractical/ɪmˈpræktɪkl/adj. 不切实际的，不现实的；不能实行的 有道翻译（仅供参考，建议自己翻译）： 早期并发症 血管损伤 胫骨近半部骨折可损伤腘动脉。这是头等大事，需要勘探和修理。如果没有严重的缺血，两个主要的胫骨血管中的一个也可能发生损伤而不被注意到。 骨筋膜室综合征 胫骨骨折-开放性和闭合性骨折-是腿部骨筋膜室综合征最常见的原因之一。组织水肿和出血（渗出）共同导致肌肉室肿胀，这可能导致缺血。其他危险因素包括胫骨近端骨折、严重挤压伤、血运重建前长时间缺血（IIIC型开放性骨折）、治疗延迟时间长、出血性休克、手术难度大和时间长以及骨折牵张固定。 这种诊断通常以临床为依据。警告症状是疼痛加剧，腿部感到紧绷或“爆裂”，腿部或足部麻木。应始终认真对待这些投诉，然后仔细和反复检查肌肉拉伸和失去敏感性和/或肌力引起的疼痛。 提高意识就是一切！可以通过测量腿部的腔室压力来确认诊断。事实上，早期诊断的必要性非常重要，因此一些外科医生主张对所有胫骨骨折使用连续的腔室压力监测（McQueen et al.，1996）。这对昏迷或不合作的病人以及多发伤的病人来说是非常好的。在问题较少的情况下，它还可以作为“早期预警系统”。将一个20号裂尖导管引入腿部前室，在接近骨折水平处测量压力（Heck man等人，1994）。小于30 mmHg（4.00 kPA）的压差（ΔP）——舒张压和室间压之间的差值——被视为临界值，是室间减压的指征。理想情况下，应测量所有四个腔室的压力，但这通常是不切实际的；然而，如果临床特征提示腔室综合征，前房压力正常或处于临界状态，则应测量其他腔室的压力。 |
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