骨科英文书籍精读（23）｜
EXERCISE
More correctly, restore function – not only to the injured parts but also to the patient as a whole. The objectives are to reduce oedema, preserve joint movement, restore muscle power and guide the patient back to normal activity:
Prevention of oedema Swelling is almost inevitable after a fracture and may cause skin stretching and blisters. Persistent oedema is an important cause of joint stiffness, especially in the hand; it should be prevented if possible, and treated energetically if it is already present, by a combination of elevation and exercise. Not every patient needs admission to hospital, and less severe injuries of the upper limb are successfully managed by placing the arm in a sling; but it is then essential to insist on active use, with movement of all the joints that are free. As with most closed fractures, in all open fractures and all fractures treated by internal fixation it must be assumed that swelling will occur; the limb should be elevated and active exercise begun as soon as the patient will tolerate this. The essence of soft-tissue care may be summed up thus: elevate and exercise; never dangle, never force.
Elevation An injured limb usually needs to be elevated; after reduction of a leg fracture the foot of the bed is raised and exercises are begun. If the leg is in plaster the limb must, at first, be dependent for only short periods; between these periods, the leg is elevated on a chair. The patient is allowed, and encouraged, to exercise the limb actively, but not to let it dangle. When the plaster is finally removed, a similar routine of activity punctuated by elevation is practised until circulatory control is fully restored.
Injuries of the upper limb also need elevation. A sling must not be a permanent passive arm-holder; the limb must be elevated intermittently or, if need be, continuously.
Active exercise Active movement helps to pump away oedema fluid, stimulates the circulation, prevents softtissue adhesion and promotes fracture healing. A limb encased in plaster is still capable of static muscle contraction and the patient should be taught how to do this. When splintage is removed the joints are mobilized and muscle-building exercises are steadily increased. Remember that the unaffected joints need exercising too; it is all too easy to neglect a stiffening shoulder while caring for an injured wrist or hand.
Assisted movement It has long been taught that passive movement can be deleterious, especially with injuries around the elbow, where there is a high risk of developing myositis ossificans. Certainly forced movements should never be permitted, but gentle assistance during active exercises may help to retain function or regain movement after fractures involving the articular surfaces. Nowadays this is done with machines that can be set to provide a specified range and rate of movement (‘continuous passive motion’).
Functional activity As the patient’s mobility improves, an increasing amount of directed activity is included in the programme. He may need to be taught again how to perform everyday tasks such as walking, getting in and out of bed, bathing, dressing or handling eating utensils. Experience is the best teacher and the patient is encouraged to use the injured limb as much as possible. Those with very severe or extensive injuries may benefit from spending time in a special rehabilitation unit, but the best incentive to full recovery is the promise of re-entry into family life, recreational pursuits and meaningful work.
---from 《Apley’s System of Orthopaedics and Fractures》P705-706
重点词汇整理：
restore /rɪˈstɔːr/vi. 恢复；还原vt. 恢复；修复；归还
oedema /ɪˈdiːmə/n. [病理] 水肿；[植] 瘤腺体
inevitable /ɪnˈevɪtəbl/adj. 必然的，不可避免的
skin stretching and blisters皮肤拉伸和起水泡
blisters /'blɪstɚ/n. [医] 水疱；（blister的复数）
admission to hospital入院,住院
assume /əˈsuːm/vt. 假定vi. 设想
assess/əˈses/vt. 评定；估价；对…征税
access /ˈækses/v. 接近，使用；访问，存取（电脑文档）n. 通道；进入
summed up概括，归纳；总结
dangle/ˈdæŋɡl/v. （使）摇晃地悬挂着；提着；炫示；用……来诱惑（或激励）
upper limb上肢
passive /ˈpæsɪv/adj. 被动的，消极的；被动语态的
positive /ˈpɑːzətɪv/ 积极的
intermittently /ˌɪntərˈmɪtəntli/adv. 间歇地
continuously/kənˈtɪnjuəsli/adv. 连续不断地
Active exercise 自动运动
static muscle contraction静态的肌肉收缩
static /ˈstætɪk/n. 静电；静电干扰adj. 静态的；静电的；静力的
Assisted movement 辅助运动
deleterious /ˌdeləˈtɪriəs/adj. 有毒的，有害的
myositis ossificans.骨化性肌炎 /,maiəu'saitis/
retain /rɪˈteɪn/vt. 保持；雇；记住
CPM (continuous passive motion)连续被动运动
handling eating utensils 使用餐具
utensil /juːˈtensl/n. 用具，器皿
extensive injuries重伤
extensive/ɪkˈstensɪv/adj. 广泛的；大量的；广阔的
rehabilitation unit, 康复单元
incentive /ɪnˈsentɪv/n. 动机；刺激adj. 激励的；刺激的
recreational pursuits 娱乐活动
recreational /ˌrekriˈeɪʃənl/adj. 娱乐的，消遣的；休养的
百度翻译：
锻炼
更准确地说，恢复功能-不仅对受伤部位，而且对整个患者。目的是减少水肿，保持关节活动，恢复肌肉力量，引导患者恢复正常活动：
预防水肿肿胀几乎是不可避免的骨折后，可能导致皮肤拉伸和水泡。持续性水肿是关节僵硬的一个重要原因，尤其是在手部；如果可能的话，应该预防水肿，如果已经出现，应该通过仰卧起坐和运动的结合来进行积极治疗。并不是每个病人都需要入院治疗，而较轻的上肢损伤可以通过将手臂放在吊带中成功地得到治疗；但是，必须坚持积极使用，所有关节都可以自由活动。与大多数闭合性骨折一样，在所有开放性骨折和所有通过内固定治疗的骨折中，必须假定会发生肿胀；一旦患者能够耐受，应抬高四肢并开始积极锻炼。软组织护理的精髓可以概括为：提升和锻炼；从不摇晃，从不用力。
抬高受伤的肢体通常需要抬高；腿部骨折复位后，床脚抬高，开始锻炼。如果腿是用石膏固定的，那么首先，腿必须只靠很短的一段时间；在这两段时间之间，腿必须在椅子上抬起。允许并鼓励患者积极锻炼肢体，但不要让其摆动。当石膏最终被移除时，在循环控制完全恢复之前，会进行类似的以仰角为标点的活动。
上肢损伤也需要抬高。吊带不能是永久的被动臂托；必须间歇性地或（如果需要的话）持续地抬高肢体。
积极运动积极运动有助于排出水肿液，刺激循环，防止软组织粘连，促进骨折愈合。用石膏包住的肢体仍然能够静态收缩肌肉，应该教会病人如何这样做。当夹板被移除时，关节活动起来，肌肉锻炼稳步增加。记住，未受影响的关节也需要锻炼；在护理受伤的手腕或手时，很容易忽视僵硬的肩膀。
辅助运动长期以来人们一直认为被动运动是有害的，尤其是肘部周围的损伤，在那里很有可能发展成骨化性肌炎。当然，不应允许强迫运动，但在活动性运动中的温和帮助可能有助于在关节面骨折后保持功能或恢复运动。现在，这是通过机器来完成的，这些机器可以设置为提供指定的运动范围和速率（“连续被动运动”）。
功能性活动随着患者活动能力的提高，项目中包含了越来越多的定向活动。他可能需要再次学习如何执行日常任务，如散步、上下床、洗澡、穿衣或处理餐具。经验是最好的老师，鼓励病人尽量使用受伤的肢体。那些伤势严重或严重的人可以在一个特殊的康复单位呆上一段时间，但要完全康复，最好的激励是承诺重新进入家庭生活、娱乐活动和有意义的工作。