英汉对照骨科患者指南007：踝关节骨性关节炎（上）
Ankle Arthritis
踝关节炎
A Patient’s Guide to Osteoarthritis of the Ankle
踝关节骨性关节炎患者指南
Introduction
简介
This is due to the wear and tear that occurs over the years after the injury. This condition is called (OA) or posttraumatic . Trauma means injury, and the term posttraumatic arthritis is used to describe arthritis that develops after an injury.
关节受伤后的数年内，关节软骨或周围韧带继续磨损或撕裂，会发生骨关节炎，或称为创伤后关节炎。创伤意味着损伤，而术语创伤后关节炎用于描述受伤后引起的关节炎。
This guide will help you understand
该指南便于你理解：
· how arthritis of the ankle develops
· how doctors diagnose the condition
· what treatment options are available
踝关节炎的形成
医生如何诊断
有哪些有效的治疗选择
Anatomy
解剖
How does the work?
踝关节是如何工作的？
The ankle joint is made up of three bones: the lower end of the tibia (shinbone), the fibula (the small bone of the lower leg), and the talus (the bone that fits into the socket formed by the tibia and fibula).
踝关节由三块骨头组成：胫骨（胫骨）的下端，腓骨（小腿的小骨），和距骨（坐落在由胫骨和腓骨形成的关节窝里）。
The talus sits on top of the calcaneus (the heelbone). The talus moves mainly in one direction. It works like a hinge to allow your to move up and down.
距骨坐在跟骨（脚后跟骨）的顶部。距骨主要在一个方向上活动。它像一个铰链，让你的脚向上和向下移动。
Ligaments on both sides of the ankle joint help hold the bones together. Many tendons cross the ankle to move the ankle and the toes. (Ligaments connect bones to bones while tendons connect muscles to bones.) The large in the back is the most powerful tendon in the foot. It connects the calf muscles to the heel bone and gives the foot the power for walking, running, and jumping.
踝关节两侧的韧带有助于保持各骨相连。许多肌腱交叉穿行有利于脚踝和脚趾的移动。（韧带连接于骨与骨之间，而肌腱连接肌肉与骨骼。）后方大跟腱是足部最强大的肌腱。它连接小腿肌肉与脚后跟骨，并为脚的行走，跑步和跳跃提供力量。
Inside the joint, the bones are covered with a slick, smooth material called . Articular cartilage is the material that allows the bones to move against one another in the joints of the body. The cartilage lining is about one-quarter of an inch thick in most joints that carry body weight, such as the ankle, , or. It is soft enough to allow for shock absorption but tough enough to last a lifetime, as long as it is not injured.
关节内部，骨头表面都覆盖着一层灵活而光滑的、被称为关节软骨的物质。关节软骨是允许的骨头相对于身体的关节彼此来回移动的物质。大多数关节的软骨内衬是约四分之一英寸厚，用来承受体重，如踝关节，髋关节，膝关节。它足够柔软用来减震，而又足够坚固，只要不受伤，可一生受用。
Related Document:
相关阅读：英汉对照骨科患者指南001：踝关节解剖
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Causes
病因
Why do I have this problem?
为什么我会出现问题？
OA is usually considered a type of degenerative arthritis, or wear-and-tear arthritis. Doctors consider OA pretty much the same whether it appears years after an injury to the joint or whether it appears without any history of injury. It behaves more or less the same way.
骨关节炎通常被认为是退行性关节炎的一种类型，或磨损—撕裂关节炎。医生认为，骨关节炎几乎相同，与是否受到过损伤无关。它的临床表现都差不多。
Over the past several years, there has been increasing evidence that OA is genetic, meaning that it runs in families. OA that occurs without any injury may prove to be related to differences in the chemical makeup of articular cartilage. People are born with these differences.
在过去的几年中，已经有越来越多的证据表明，骨关节炎会遗传的，这意味着它在家族中会出现。无受伤史出现的骨关节炎有可能被用来证明其发病是与关节软骨化学组成的差异有关。人们天生就有这些差异。
Injury to a joint, such as a bad sprain or fracture, can cause damage to the articular cartilage. The cartilage can be bruised when too much pressure is exerted on it. This damages the cartilage, although if you look at the surface it may not appear to be any different. The injury to the material doesn’t show up until months later. Sometimes the cartilage surface is damaged even more severely, and pieces of the cartilage are ripped from the bone. These pieces do not heal back and usually must be removed from the joint surgically. If not, they may float around in the joint, causing the joint to catch and be painful. These fragments of cartilage may also do more damage to the joint surface.
关节损伤，如扭伤或骨折，可引起对关节软骨的损伤。当压力太大时软骨有可能会磨损。此时损伤的软骨，如果你光看表面，可能不会出现任何不同。这种损伤一般都是几个月后才会被发现。有时软骨表面损伤比较严重，甚至软骨碎片从骨头上撕脱。这些碎片不会愈合，通常需要通过关节手术摘除。如果不这样，它们可在关节内游离，卡住关节并引起疼痛。这些软骨碎片还会给关节面带来更多的伤害。
Once this cartilage is ripped away, it does not normally grow back. Unlike bone, holes in the surface are not simply replaced by the cartilage tissue around the hole. Instead the defects are filled with scar tissue. The scar tissue that forms is not nearly as good a material for covering joint surfaces as the cartilage it replaces. It just can’t support weight and isn’t smooth like true articular cartilage.
一旦软骨撕裂了，它通常不会重新长出。不像骨头，表面裂孔不会简单地通过裂孔周围的软骨组织所取代。不过这些缺陷会被疤痕组织填充。形成的疤痕组织没有覆盖在关节表面的它所取代的那块软骨那么好。它无法支撑体重，也不如真正的关节软骨光滑。
An injury to a joint, even if it does not injure the articular cartilage directly, can alter how the joint works. This is true for a fracture where the bone fragments heal differently from the way they were before the break occurred. It is also true when ligaments are damaged that lead to instability in the joint. When an injury results in a change in the way the joint moves, the injury may increase the forces on the articular cartilage. This is similar to any mechanical device or machinery. If the mechanism is out of balance, it wears out faster.
关节受到损伤，即使没有直接损伤到关节软骨，但依然可以改变关节的运行。事实上，它与骨折发生前后碎骨的处理完全不同。当韧带受损，会导致关节不稳定，这也是真的。当这些损伤引起关节运动方式改变，损伤可能加重关节软骨的受力情况。这类似于其他机械设备或机器。如果该机制失去平衡，其磨损更快。
Over many years this imbalance in the joint mechanics can lead to damage to the articular surface. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint is no longer able to compensate for the increasing damage, and it begins to hurt. The damage occurs well before the pain begins.
多年来这种不平衡的关节机制可导致关节面的损伤。由于关节软骨不能非常好得自行愈合，伤害逐渐累积。最后，关节不再能够代偿持续增加的损害，并且它开始疼痛。损伤往往发生在疼痛开始之前。
In summary, arthritis may come from differences in how each of us is put together based on our genes, a condition best described as OA. Or arthritis may develop years after an injury that leads to slow damage to the joint surfaces, a condition probably best described as post-traumatic arthritis. Either way the joint is worn out, and it hurts. For the purposes of this document, we will refer to both types as OA.
综上所述，关节炎的发生可能源于我们的基因组成差异，这种情况最好的描述为骨性关节炎。或关节炎可能是由于受伤后导致多年的关节面的慢性损伤发展而成，这种情况最好的描述为创伤性关节炎。无论哪种方式的关节磨损，甚至疼痛。对于此文章的目的，我们会参考这两种类型的骨关节炎。
Symptoms
症状
What does arthritis of the ankle feel like?
踝关节炎有何表现？
Pain is the main problem with arthritis of any joint. This pain occurs at first only related to activity. Usually, once the activity gets underway there is not much pain, but after resting for several minutes the pain and stiffness increase. Later, when the condition worsens, pain may be present even at rest. The pain may interfere with . The joint may swell, fill with fluid, and feel tight, especially following increased activity. As the articular cartilage starts to wear off the joint surface, the joint may squeak when moved. Doctors refer to this sound as crepitation.
疼痛是所有关节炎的主要问题。第一次疼痛的发生仅仅是和活动有关。通常，活动进行中没有太多的痛苦，但休息几分钟后疼痛和僵硬就会加重。后来，当情况更加严重，即使在休息，疼痛也可存在。疼痛可能干扰睡眠。关节可能会肿胀，充满积液，感觉紧绷，尤其在接下来的活动中会加重。由于关节软骨开始脱离关节面，在移动时关节可能会发出吱吱声。医生称这声音为捻发音。
OA will eventually affect the motion of a joint. The joint becomes stiff and loses flexibility. Certain movements can become painful, and it may become difficult to trust the joint to hold your weight in certain positions. The body has a pain reflex such that when a joint is put into a position that causes pain the muscles around the joint may stop working without warning. This reflex can cause a person to stumble or even fall when arthritis affects the ankle joint.
骨关节炎最终会影响关节的运动。关节逐渐变得僵硬，失去灵活性。某些动作会诱发疼痛，可能造成在某个特定的位置，关节支撑你的体重变得难以胜任。人体有疼痛反射，当关节处于某个特定位置会导致疼痛，关节周围的肌肉可能会不自主地停止工作。当关节炎影响踝关节时，这种反射可能会导致一个人颤抖甚至摔倒。
When OA has reached a very severe stage, the bone itself under the articular cartilage may become worn away. This can lead to increasing deformities around the joint. In the final stages, the alignment of the bones can begin to form odd angles where they meet at the joint.
当骨关节炎已经达到了非常严重的阶段，关节软骨下方骨关节面可能会磨掉。这可能会导致关节周围畸形加重。在最后阶段，骨骼开始形成多角度契合关节的排列。
Diagnosis
诊断
How do doctors identify OA?
医生如确诊骨关节炎？
The diagnosis of OA begins with a history of the problem. Details about any injuries that may have occurred to the joint, even years before, are important to understanding why the condition exists. Whether or not other family members have OA may shed some light on the problem.
骨关节炎的诊断开始于出现问题的病史。关于关节可能损伤的任何细节，甚至几年前发生的，对于理解为什么存在这种情况是非常重要的。其他家庭成员是否患有骨关节炎可以帮助阐明问题的一些情况。
Following the history, your doctor will examine the ankle joint and possibly other joints in your body. It will be important for your doctor to see how the motion of the ankle has been affected. The alignment of the ankle will be assessed. The nerves and circulation going to the legs and ankle will be checked. Your doctor will watch you walk to see if you have a noticeable limp.
顺着病史，医生会检查你的踝关节和身体其他可能相关的关节。这对医生查看脚踝的运动受到哪些影响是很重要的。脚踝的定位排列将被评估。到腿部和踝部的神经和血液循环将被检查。医生会看着你走路，看看是否有明显跛行。
Regular X-rays will be taken to see how severely the joint is damaged. This is usually the most important test to determine how bad the OA has become. How much articular cartilage is left in the ankle joint can be estimated with the X-rays.
常规的X光片会看到关节受损严重程度。这通常是最重要的检查，以确定骨关节炎的严重程度。踝关节还有多少关节软骨存留也可用X射线来估计。
If there is any question whether the arthritis may be coming from something other than OA, blood tests may be ordered to look for systemic diseases such as . A needle may be inserted into the joint to remove some of the joint fluid. This fluid may be sent to a lab to look for crystals due to gouty arthritis or signs of infection.
除了骨关节炎，关节炎是否还有可能来自其他情况，验血可以用来寻找全身性疾病，如风湿性关节炎。一个针插入关节以抽取一些关节液。该液体可被送到实验室以寻找痛风性关节炎晶体或感染迹象。
（韩健勇 译 魏鹏 校）
韩健勇，男，主治医师，毕业于第二军医大学。
魏鹏， 宁波市第一医院/浙江大学宁波医院骨科中心副主任、手足及显微创伤外科主任,副主任医师，硕士生导师,宁波市领军和拔尖人才，国际矫形与创伤外科学会（SICOT）中国部显微外科学组委员、中国医疗保健国际交流促进会足踝外科学组委员，中华医学会骨科学分会足踝外科学组青年委员，中国生物材料学会脊髓与周围神经修复学组委员、宁波市医学会骨科学分会足踝学组组长（筹）、《中华显微外科杂志》、《中华临床医师杂志》、《现代实用医学杂志》等多家杂志特约编辑。原宁波六院手外科医疗及教学秘书、医疗组组长，宁波大学附属医院手足显微外科创建人、负责人。国内核心医学期刊发表科研论文30余篇，参编国家十二五规划高校教材2部，参编医学专著1部，参译医学2部，主持浙江省重中之重课题1项、宁波市自然科学基金2项、社会发展等科研项目2项，宁波大学校级课题2项。
曾获浙江省自然科学优秀论文三等奖、宁波市自然科学优秀论文三等奖、院级“十佳优秀青年医师”、“宁波市农工党优秀党员”等奖项及荣誉。
技术专长：断肢（指、趾）再植，四肢骨关节损伤，严重肢体毁损伤的保肢治疗，各类皮瓣修复四肢皮肤缺损、四肢创伤的显微修复重建，周围神经卡压、上肢、颈肩部及足踝部疼痛的诊治，手足先天畸形矫形，拇外翻、平足、马蹄足、小儿麻痹症及脑瘫后遗症的四肢畸形矫形等疾病诊治，肘、腕、踝关节疾病的微创内镜治疗，糖尿病足的综合治疗，严重创伤后的晚期手部功能手术重建及功能康复指导，足趾移植拇手指再造，肩肘手部各关节的人工关节置换、手部骨关节炎、上肢肿瘤等方面的诊治，手足部特殊感染、难治性骨髓炎、难治性创面等治疗。