骨科英文书籍精读（326）｜股四头肌肌腱损伤
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RUPTURE OF PATELLAR LIGAMENT
This is an uncommon injury; it is usually seen in young athletes and the tear is almost always at the proximal or distal attachment of the ligament. There may be a previous history of 'tendinitis’ and local injection of corticosteroid.
The patient gives a history of sudden pain on forced extension of the knee, followed by bruising, swelling and tenderness at the lower edge of the patella or more distally.
X-rays may show a high-riding patella and a tell-tale flake of bone torn from the proximal or distal attachment of the ligament.
MRI will help to distinguish a partial from a complete tear.
Treatment
ACUTE TEARS
Partial tears can be treated by applying a plaster cylinder. Complete tears need operative repair or reattachment to bone. Tension on the suture line can be lessened by inserting a temporary pull-out wire to keep the distance between the inferior pole and attachment to the tibial tuberosity constant. Immobilization in full extension may precipitate stiffness – it is, after all, a joint injury – and it may be better to support the knee in a hinged brace with limits to the amount of flexion permitted. This range can be gradually increased after 6 weeks.
Early repair of acute ruptures gives excellent results. Late repairs are less successful and the patient may be left with a permanent extension lag.
LATE CASES
Late cases are difficult to manage because of proximal retraction of the patella. A two-stage operation may be needed: first to release the contracted tissues and applytraction directly to the patella, then at a later stage to repair the patellar ligament and reinforce it with grafts of tendon from gracilis or semitendinosus. Here, again, a tension-relieving pull-out wire is helpful. Postoperatively a hinged brace is used to hold the knee in extension with supervised knee movement and limits to the amount of flexion until the repair is healed, usually at 12 weeks.
---from 《Apley’s System of Orthopaedics and Fractures》
重点词汇整理：
local injection of corticosteroid.局部注射皮质类固醇。
corticosteroid. /,kɔrtɪko'stɪr,ɔɪd; /kɔrtɪko'ster,ɔɪd/n. [生化] 皮质类固醇；皮质甾（类）
flake of bone骨片
tibial tuberosity 胫骨粗隆
Immobilization in full extension may precipitate stiffness 完全伸展的固定可能会导致僵硬
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
prognosis /prɑːɡˈnoʊsɪs/n. [医] 预后；预知
extension lag伸直受限
gracilis or semitendinosus股薄肌和半腱肌
有道翻译（仅供参考，建议自己翻译）：
RUPTURE OF PATELLAR LIGAMENT 髌骨韧带断裂
This is an uncommon injury; 这是一种罕见的损伤;it is usually seen in young athletes and the tear is almost always at the proximal or distal attachment of the ligament. 它通常见于年轻运动员，撕裂几乎总是在韧带的近端或远端附着处。There may be a previous history of 'tendinitis’ and local injection of corticosteroid. 可能有“肌腱炎”和局部注射皮质类固醇的历史。
The patient gives a history of sudden pain on forced extension of the knee, followed by bruising, swelling and tenderness at the lower edge of the patella or more distally. 患者有膝关节被迫伸展时突然疼痛的病史，随后髌骨下缘或更远端有瘀伤、肿胀和压痛。
X-rays may show a high-riding patella and a tell-tale flake of bone torn from the proximal or distal attachment of the ligament. x光片可显示高强度髌骨和韧带近端或远端连接处撕裂的片状片状骨。
MRI will help to distinguish a partial from a complete tear. MRI将有助于区分局部撕裂和完整撕裂。
Treatment 治疗
ACUTE TEARS 急性撕裂
Partial tears can be treated by applying a plaster cylinder. 局部撕裂可以用石膏筒来治疗。Complete tears need operative repair or reattachment to bone. 完全撕裂需要手术修复或骨再附着。Tension on the suture line can be lessened by inserting a temporary pull-out wire to keep the distance between the inferior pole and attachment to the tibial tuberosity constant. 通过插入一根临时的拉出线可以减少缝合线上的张力，以保持下极与胫骨结节附着之间的距离恒定。Immobilization in full extension may precipitate stiffness – it is, after all, a joint injury – and it may be better to support the knee in a hinged brace with limits to the amount of flexion permitted. 完全伸展的固定可能会导致僵硬，毕竟这是一种关节损伤，最好在允许屈曲的范围内用铰链支撑膝盖。This range can be gradually increased after 6 weeks. 这个范围可以在6周后逐渐增加。
Early repair of acute ruptures gives excellent results. 急性破裂早期修复效果良好。Late repairs are less successful and the patient may be left with a permanent extension lag. 晚期的修复不太成功，病人可能会留下永久的延迟。
LATE CASES 晚期病例
Late cases are difficult to manage because of proximal retraction of the patella. 晚期病例由于髌骨近端回缩而难以处理。A two-stage operation may be needed: first to release the contracted tissues and applytraction directly to the patella, then at a later stage to repair the patellar ligament and reinforce it with grafts of tendon from gracilis or semitendinosus. 可能需要两个阶段的手术:首先释放收缩的组织，直接对髌骨施加牵引，然后在后期重新配对髌骨韧带，用股薄肌或半腱肌腱移植物进行加固。Here, again, a tension-relieving pull-out wire is helpful. 这里，再一次，一根可以缓解紧张的牵引线是有帮助的。Postoperatively a hinged brace is used to hold the knee in extension with supervised knee movement and limits to the amount of flexion until the repair is healed, usually at 12 weeks. 术后通常在第12周，使用铰链式支具来保持膝关节伸展，并监督膝关节运动和限制屈曲量，直到修复愈合。