Unit9-A Surgical Diseas

1、Introduction to bone fracture 骨折的概述A bone fracture is a medical condition in which there is a break in the continuity of the bone. 骨的连续性破坏称为骨折。A bone fracture can be the result of high force impact or stress, or trivial injury as a result of certain medical conditions that weaken the bones，such as o

2、steoporosis，bone cancer，or osteo-genesis imperfecta, where the fracture is then properly termed a pathologic fracture.骨折可由高冲击力或压力，或者是在骨骼疾病导致骨骼削弱的基础上轻微的损伤造成，比如骨质疏松、骨肿瘤、成骨不全常也被称为病理性骨折。What causes a bone fracture?When outside forces such as a direct blows or falls are applied to bone it has the potenti

3、al to fail. 当外部力量比如直接打击或跌倒时施加于骨头导致它有可能承受不了。Fractures occur when bone cannot withstand those outside forces. 骨折发生在骨不能承受这些外部力量。Fracture break，or crack all mean the same thing. 断裂或裂缝都意味着骨折。One term does not imply a more or less severe injury. 这并不意味着损伤的轻重。The integrity of the bone has been damaged，which

4、 causes the bone structure to fail, which results in a fracture or broken bone. 骨的完整性已被破坏，这会导致骨结构的破坏，从而导致骨折。Often a fracture is easy to detect because there is obvious deformity. 通常骨折易于检测，因为有明显的畸形。However, at times it is not easily diagnosed. It is important for the physician to take a history of th

5、e injury to decide what potential problems might exist. 然而，有时它是不容易诊断。医生采集受伤中的病史是非常重要的，这能够确定潜在可能存在的问题。Moreover，fractures dont always occur in isolation，and there may be associated injuries that need to be addressed.此外，骨折并不是常常完全离断，同时骨折常带来一些附带损伤需要解决。Fractures can occur because of direct blows, twisting

6、 injuries, or falls. 直接打击，扭转受伤，或跌倒常导致骨折发生。The type of forces or trauma applied to the bone may determine what type of injury that occurs. 施加于骨的作用力或损伤的类型，可以确定发生的损伤类型。Some fractures occur without any obvious trauma due to osteoporosis，the loss of calcium in bone (for example a compression fracture of

7、the vertebrae of the back) or a congenital bone cyst that has been present since birth, which causes a weak area in the bone.有些骨折没有明显的外伤，因为骨质疏松，骨质钙流失（例如背部的脊椎骨压缩性骨折）或因为出生时先天性骨囊肿，它会导致骨中的薄弱区域。Descriptions of fractures can be confusing. They are based on：骨折的描述可能令人困惑。他们是基于:Where in the bone the break has

8、 occurred在骨折发生的地方How the bone fragments are aligned 骨折的碎片怎样对齐Whether any complications exist是否存在任何并发症Whether the skin is intact皮肤是否完好 The first step in describing a fracture is to decide if it is open or closed. 首先第一步要确定骨折是开放性的还是闭合性的。The skin protects the inside of the body，including bones, from the

9、 outside world.皮肤可以保护身体内部，包括防止骨头暴露外界。If the skin over the break is disrupted, then an open fracture exists. 如果皮肤被破坏，则为开放性骨折。The skin can be cut, tom, or abraded (scraped)，but if the skin's integrity is damaged, the potential for an infection from the outside world to get into the bone exists. 皮肤

10、会被切割或磨（刮），但是如果皮肤完整性受损，潜在的感染从外界获得。Since the fracture site in the bone communicates with the outside world, these injuries often need to be cleaned out aggressively and many times require anesthesia in the operating room to do the job effectively. 当骨折端与外界相通，这些损伤需要积极的清创缝合，大部分时候需要麻醉下在手术室完成。Compound frac

11、ture was the previous term used to describe an open fracture.复合骨折是用来形容开放性骨折的前一个术语。Next, there needs to be a description of the fracture line. 接下来，需要描述骨折线。Does the fracture line go across the bone (transverse) ,at an angle (oblique) or does it spiral? 骨折线是否（横向）穿过骨，穿过的角度（斜），穿过是否有螺旋？Is the fracture in

12、two pieces or is it comminuted, in multiple pieces?骨折是分为两块，粉碎状，亦或是多块？A greenstick fracture describes the situation when the bone partially breaks. 青枝骨折介绍的情况是骨部分断裂。This often oc¬curs in infants and children where the bone hasnt completely calcified and has the potential to bend instead of breaki

13、ng completely through. 这通常发生在婴儿和儿童，这些骨质没有完全钙化，弯曲的潜力完成传导而不是完全断裂。It is similar to trying to break off a young branch or shoot from a tree (a green stick). 就像是试着折断新发的树枝或射击绿色的树。Other fracture terms include torus or buckle fracture, again when only part of a bone breaks,but this may occur in adults as we

14、ll.其他骨折包括圆环或扣断裂，同样是骨头的部分断裂，但这同样发生在成年人。Finally, the fractures alignment is described as to whether the fracture fragments are dis¬placed or in their normal anatomic position. 最后，骨折的排列是描述 骨折碎片是否移位或在正常解剖位置。If the bones fragments arent in the right place, they need to be reduced or “set” and placed

15、 back into normal alignment.如果骨头碎片不在正确的地方，他们需要更少或“设置”步骤来放回正常位置。 What are the signs and symptoms of a bone fracture ?When bones break, they cause pain, swelling, and inflammation. 当骨头断裂，它们会引起疼痛、肿胀和发炎The ability to move the joint above or below an injury does not guarantee that the bone is not broken.

16、 Instead, it means that the muscles and tendons that move the joint still work.受伤的关节的上下方移动的能力不能保证没有骨折。相反，这意味着移动关节的肌肉和肌腱仍然工作。Unless there is a previous underlying condition that prevents the patient from feeling pain (such as a spinal cord injury or diabetic neuropathy) all broken bones hurt. 除非有一个前提

17、条件，防止病人感觉疼痛（如脊髓损伤或糖尿病神经病变）所有骨折都会出现疼痛。The pain may or may not be felt at the site of the break but can be referred elsewhere. For example, hip injuries, especially in children, can have knee pain.疼痛可能发生在断裂的地方，但也可能发生在其他部位。例如，髋关节受伤，特别是在儿童，可以出现膝关节痛。Other structures can be damaged when a bone breaks. Num

18、bness and tingling can result if there is nerve inflammation or injury. 当骨断裂时其他结构可能出现损坏。如果有神经发炎或受伤可以导致麻木和刺痛。A limb may be cool and without pulse if the artery at the fracture site is torn, kinked or clots off, preventing blood from circulating.如果在骨折部位的动脉撕裂、扭曲或断裂，阻断血液循环可能出现肢体变冷，无动脉波动。What are common

19、types of bone fractures ? 常见的骨折类型都有那些类型？There are several types of bone fractures，for example，stress fractures, compression fractures, open fractures, skull fractures，rib fractures, wrist fractures, hip fractures, leg fractures, and hand, toe, or finger fractures.骨折包括很多类型，比如：应力性骨折，压缩骨折，开放性骨折，颅骨骨折，肋骨

20、骨折，腕部骨折，髋部骨折、腿部骨折、手骨折、足趾骨折、手指骨折等。How is a bone fracture diagnosed ? 骨折是怎样诊断的？The story of the injury is often key to proper diagnosis. Where，when，and why did the injury occur? Did the person trip and fall，or did they pass out before the fall? 受伤的病史往往是正确诊断的关键。受伤的地点，时间，受伤的原因？病人是摔倒还是坠落，坠落前是否已经昏迷？Are th

21、ere other injuries that take precedence over the fracture? For example, a person who falls and hurts their wrist because they had a stroke or heart attack will have their fracture care delayed to allow care for the life threatening illness. A multiple trauma victim may have their orthopedic surgery

22、delayed to address bleeding in the brain, chest or abdomen.其他损伤需要提前吗？例如，一个人跌倒后手腕受伤，因为他们有中风或心脏病发作，将他们的骨折治疗延迟，优先照顾有生命威胁的疾病。一个多发伤的患者先解决脑，胸部或腹部出血，创伤手术需要延后。Physical exam follows the history of the injury. The injured area will be examined and a search will happen for potential associated injuries. These

23、include damage to skin，arteries and nerves.体格检查应遵循受伤的病史进行。受伤的区域将被检查，潜在的附带损伤部位也将一并检查。附带损伤包括对皮肤、动脉和神经的损害。Pain control is a priority and many times, pain medication will be prescribed before the diagnosis is made. If the health care professional believes that an operation is potentially required ，pain

24、medication will be given through an intravenous ( IV ) line or by an injection into the muscle. This allows the stomach to remain empty for anesthesia.控制疼痛是优先事项，很多时候，在确定诊断前给予止痛药物。如果卫生保健专业人员认为需要手术治疗，则止痛药会通过静脉注射或肌肉注射的方法给病人止痛。其目的是保持胃排空状态为麻醉做准备。A decision will be made whether X-rays are required, and wh

25、ich type of X-ray should be taken to make the diagnosis and better assess the injury. 作出决定是否需要进行X射线检查，应采取哪种类型的X射线利于诊断，能更好地评估损伤。There are guidelines in place to help health care professionals decide if an X-ray is necessary. 指导原则可以帮助卫生保健专业人员决定，X射线是否必要。Some include the Ottawa ankle and knee X-ray rule

26、s. 这包括渥太华关于踝关节和膝关节X射线的相关规则。These rules were developed to minimize the number of X-rays taken, and decrease the radiation in which a patient is exposed. 这些规则能够尽量减少所X-射线检查的数目，并减少患者的辐射暴露。The body is three dimensional，and plain film X-rays are only two dimensional. Therefore, two or three X-rays of the

27、injured areas may be taken in different positions and planes to give a true picture of the injury. Sometimes the fracture will not be seen in one position, but is easily seen in another.身体是三维的，而普通的X光片是二维的。因此，在不同的位置和平面上，可能会对受伤部位进行2-3次X射线检查以真实反应受伤部位。有时，在一个角度上骨折不会被看到，但在另一个角度很容易看到。There are areas of the

28、 body where one bone fracture is associated with another fracture at a more distant part. 有时一些部位的骨折的原因是相对有些距离的另一个骨折部位所造成。For example, the bones of the forearm make a circle and it is difficult to break just one bone in that circle. 例如，前臂的螺旋型骨折，很难发生一根骨头出现这样的损伤。Think of trying to break a pretzel in ju

29、st one place，it is difficult to do. Therefore broken bones at the wrist may be associated with an elbow injury. Similarly ,an ankle injury can be accompanied by a knee fracture. The health care professional may X-ray areas of the body that dont initially appear to be injured.想尝试打开椒盐卷饼的一部分，这是很难做到的。因此

30、，手腕骨头的骨折可能因为肘部受伤。类似地，踝关节损伤可以伴有膝关节骨折。健康护理专业人士进行X线检查时不能只看到表面的损伤。Occasionally, the broken bone isnt easily seen, but there may be other signs that a fracture exists. 偶尔，骨折的骨头是不容易看到的，但可能有其他迹象表明，骨折存在。In elbow injuries, fluid seen in the joint on X-ray (sail sign) is an indicator of a subtle fracture. 在肘关

31、节损伤时，在X射线（间接征象）上看到的关节腔积液是细微骨折的标志。And in wrist injuries, fractures of the scaphoid or navicular bone may not show up on X-ray for one to two weeks, and diagnosis is made solely on physical examination with swelling and tenderness over the snuffbox at the base of the thumb.在手腕受伤，舟状骨骨折最初的1-2周内X射线可能不会发现

32、，诊断仅仅是通过局部的肿胀和拇指基部在鼻烟窝的压痛诊断。In children，bones may have numerous growth plates that can cause confusion when reading an X-ray. 在儿童中，骨头可能有很多的生长板，当读的X片时可以引起误判。Sometimes, the health care professional will X-ray the opposite arm, leg or joint for comparison to determine what normal is for that child befo

33、re deciding whether a fracture exists.有时，医疗保健专业人士会对相反的手臂、腿部或关节进行X射线检查，对比分析正常肢体，确定儿童是否存在骨折时。What is the treatment of a bone fracture ? 骨折的治疗是什么？In the field, the initial treatment for fractures of the arms, legs, hands and feet include splinting the extremity in the position it is found, elevation an

34、d ice. Immobilization will be very helpful with initial pain control. 在骨折发生的现场，四肢骨折（上肢、下肢）的最初级的治疗方法包括夹板固定肢体，抬高患肢或冰敷消肿。固定患肢是最早控制疼痛非常有用。For injuries of the neck and back, many times, first responders or paramedics may choose to place the injured person on a long board and in a neck collar to protect t

35、he spinal cord from potential injury. 对颈部和背部多发损伤，急救人员和医护人员可以把伤者放在长板上并用颈托保护脊髓损伤。Once the fracture has been diagnosed，the initial treatment for most limb fractures is a splint. Padded pieces of plaster or fiber glass are placed over the injured limb and wrapped with gauze and an elastic wrap to immobi

36、lize the break. 骨折易经诊断，大多数肢体骨折的初始治疗是夹板固定。用石膏或玻璃纤维块放在患肢，用纱布包好，固定休息弹性包。The joints above and below the injury are immobilized to prevent movement at the fracture site. 关节上下的骨折，须固定关节防止骨折部位出现活动。This initial splint does not go completely around the limb. 这最初的夹板不应把肢体完全固定。After a few days, the splint is rem

37、oved and replaced by a circumferential cast. 几天后，夹板被拆除，取而代之的是固定物。Circumferential casting usually does not occur initially because fractures swell (edema). 铸型固定最初是不需要的，因为骨折肿胀（水肿）。This swelling could cause a build up of pressure under the cast, yielding increased pain and the potential for damage to t

38、he tissues under the cast. 膨胀会导致建立的压力向下传导，导致增加局部疼痛，压力会造成局部组织潜在的损伤。However, if the fracture required reduction ( putting the bones back into alignment) there might be a need for circumferential cast to keep the bones in place.然而，如果骨折需要复位（将骨头重新放回），有可能需要进行铸型结构来防止骨移位。Bone fracture surgery骨折手术Surgery on

39、fractures are very much dependent on what bone is broken, where it is broken, and whether the orthopedic surgeon believes that the break is at risk for moving out of place once the bone fragments have been aligned.骨科医生关注的重点在骨折发生的部位以及复位的骨折碎片再次发生移位的风险有多高。If the surgeon is concerned that the bones will

40、 heal improperly, an operation will be needed. 如果骨科医生担心骨头会愈合不良则需要手术。Sometimes bones that appear to be aligned normally are splinted, and at a recheck appointment, are found to be unstable and require surgery at a later date. 有时骨头用夹板固定后似乎对齐，在门诊复查时发现骨折不稳定时后期仍需要手术。Surgery can include closed reduction and casting, where under anesthesia, the bones are manipulated so that alignment is restored and a cast is placed to hold the