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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。
INJURIES OF METATARSOPHALANGEAL JOINTS Sprains and dislocations of the metatarsophalangeal (MTP) joints are common in dancers and athletes. A simple sprain requires no more than light splinting; strapping a lesser toe (second to fifth) to its neighbour for a week or two is the easiest way. If the toe is dislocated, it should be reduced by traction and manipulation; the foot is then protected in a short walking cast for a few weeks. FRACTURED TOES A heavy object falling on the toes may fracture phalanges. If the skin is broken it must be covered with a sterile dressing, and antibiotics are given; a contaminated wound will require formal surgical washout and exploration. The fracture is disregarded and the patient encouraged to walk in a supportive boot or shoe. If pain is marked, the toe may be splinted by strapping it to its neighbour for 2–3 weeks. FRACTURED SESAMOIDS One of the sesamoids (usually the medial) may fracture from either a direct injury (landing from a height on the ball of the foot) or sudden traction; chronic, repetitive stress is more often seen in dancers and runners. The patient complains of pain directly over the sesamoid. There is a tender spot in the same area and sometimes pain can be exacerbated by passively hyperextending the big toe. X-rays will usually show the fracture (which must be distinguished from a smoothedged bipartite sesamoid). Treatment is often unnecessary, though a local injection of lignocaine helps for pain. If discomfort is marked, the foot can be supported in a removable boot/splint for 2–3 weeks. An insole with differential padding or cut-out under the sesamoid might also speed a return to sporting activities. Occasionally, intractable symptoms call for excision of the offending ossicle; care should be taken not to disrupt the flexor attachment to the proximal phalanx as this may result in great toe deformity. ---from 《Apley’s System of Orthopaedics and Fractures》 重点词汇整理： A simple sprain requires no more than light splinting;简单的扭伤只需要小的夹板固定; sterile dressing,消毒纱布包 /ˈsterəl/adj. 不育的；无菌的；贫瘠的；不毛的；枯燥乏味的 surgical washout外科冲洗 disregard /ˌdɪsrɪˈɡɑːrd/v. 忽视，轻视，不尊重n. 漠视，轻视 SESAMOID/ˈsesəˌmɔɪd/adj. 籽骨的；芝麻形的n. 籽骨，种子软骨 exacerbate /ɪɡˈzæsərbeɪt/vt. 使加剧；使恶化；激怒 passively hyperextending the big toe被动地过度伸展大脚趾 lignocaine /ˈlɪɡnəkeɪn/n. 利多卡因 intractable symptom棘手的（顽固的）症状 /ɪnˈtræktəbl/adj. 棘手的；难治的；倔强的；不听话的 care should be taken not to disrupt the flexor attachment to the proximal phalanx as this may result in great toe deformity. 注意不要破坏与近节指骨的屈肌附着，因为这可能导致大脚趾畸形。 DeepL翻译（仅供参考，建议自己翻译）： 跖趾关节的损伤 跖趾关节（MTP）的扭伤和脱位在舞蹈演员和运动员中很常见。简单的扭伤只需轻度夹板固定即可；将较小的脚趾（第二至第五趾）与相邻的脚趾绑在一起一到两周是最简单的方法。如果脚趾脱臼，应通过牵引和操纵使其缩小；然后用短的步行石膏保护脚部几周。 断裂的脚趾 重物落在脚趾上可能会造成趾骨骨折。如果皮肤破损，必须用无菌敷料覆盖，并给予抗生素；如果伤口被污染，则需要正式手术清洗和探查。对骨折不予理会，鼓励病人穿上支撑性的靴子或鞋子行走。如果疼痛明显，可将脚趾与邻近的脚趾绑在一起，夹板固定2-3周。 籽骨骨折 趾甲之一（通常是内侧）可能因直接损伤（从高度落在脚球上）或突然的牵引而骨折；慢性、重复性的压力更多见于舞蹈演员和跑步者。 病人诉说直接在芝麻上疼痛。在同一区域有一个压痛点，有时被动地过度伸展大脚趾会使疼痛加剧。X光片通常会显示骨折（必须与平滑的双节类脚趾区分开来）。 治疗通常是不必要的，尽管局部注射木质素食剂有助于止痛。如果有明显的不适感，可以用可脱卸的靴子/夹板支撑脚部2-3周。在足底下穿上有差异性衬垫或切口的鞋垫，也可以加快恢复运动的速度。偶尔，顽固的症状需要切除有问题的小骨；应注意不要破坏屈肌，应注意不要破坏屈肌与近端指骨的连接，因为这可能导致大脚趾畸形。 |
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