英汉对照骨科患者指南007：踝关节骨性关节炎（下）

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

Treatment

治疗

What can be done for the condition?

   这种情况该怎么办？

The treatment of OA of the ankle can be divided into the nonsurgical means to control the symptoms and the surgical procedures that are available to treat the condition. Surgery is usually not considered until it has become impossible to control the symptoms without it.

   踝关节炎的治疗可分为控制症状的非手术手段和用来根除病变的外科手术。通常不采用手术治疗，除非无其他方法控制症状。

Nonsurgical Treatment

非手术治疗

Treatment usually begins when the ankle first becomes painful. The pain may only occur at first with heavy use and may simply require the use of mild anti-inflammatory medications such as aspirin or ibuprofen. Reducing the activity or changing from occupations that require long periods of standing and walking may be necessary to help control the symptoms.

   治疗通常开始于脚踝首次出现疼痛时。第一次疼痛可能只发生在大量运动时，只需要使用温和的消炎药，如阿司匹林或布洛芬。减少活动或换掉需要长时间站立和行走的职业是必要的，以帮助控制症状。

Newer medications such as glucosamine and chondroitin sulfate are being used by orthopedic surgeons more commonly today. These medications seem to be effective in reducing the pain of OA in all joints.

较新的药物，如氨基葡萄糖和硫酸软骨素正在骨科医生中被广泛使用。这些药物似乎对所有关节炎的止痛均有效。

There are also new injectable medications that lubricate the arthritic joint. These medications have been studied mainly in the knee. It is unclear if they will help the . These injectable medications are not usually prescribed for this condition yet.

   也有新的具有润滑关节炎关节的注射药物。这些药物主要针对膝盖进行了研究。目前还不清楚是否会对踝关节炎有效。这些注射药物通常不是用于这种情况下的处方。

Rehabilitation services, such as physical therapy, play a critical role in the treatment plan for ankle joint arthritis. The main goal of therapy is to help you learn how to control symptoms and maximize the health of your ankle. You’ll learn ways to calm your pain and symptoms. You may use rest, heat, or topical rubs. Your therapist will work with you to improve flexibility, balance, and strength. Training is done to help you walk smoothly and without a limp, which may require that you use a walking aid such as a walker, crutches, or cane.

   康复服务，如物理治疗，在踝关节炎的治疗方案中起着举足轻重的作用。治疗的主要目标是帮助你学习如何控制症状，并最大限度地提高你的脚踝的健康。您将学习减轻疼痛和症状的方式。您可以使用休息，热敷，或局部摩擦。您的治疗师将与您一起来提高灵活度、平衡和力量。培训是为了帮助你走路平稳无跛行，这可能需要您使用助行器，如学步车、拐杖或手杖。

Modifying your shoe with a rocker sole may give some relief of symptoms. The rocker sole replaces your normal sole with a rounded one, allowing your foot to roll as you move through a step. This can help take stress off the ankle as you walk.

   为你的鞋子改装滚轮鞋底可能会让症状有所减轻。采用圆润的滚轮鞋底替换您的正常鞋底，让你的步行滚动向前。这可以帮你走路时减轻脚踝压力。

Braces that reduce the motion in the ankle can also be beneficial in reducing pain. Special braces that transfer some of the body weight to the knee can help protect the ankle. These braces are called  bearing braces. They are quite large and bulky and may not be well tolerated by some patients.

   用来减少脚踝活动的支具也有助于减轻疼痛。一些特殊支具将体重转移到膝盖以帮助保护脚踝。这些支具被称为髌腱支具。它们相当大而笨重，也许不能很好地被一些患者所接受。

An injection of cortisone into the joint can give temporary relief from symptoms of OA. Cortisone is a powerful anti-inflammatory medication. When injected into the joint itself, cortisone can help relieve the pain. The pain relief is temporary and usually only lasts several weeks to months. There is a small risk of infection with any injection into a joint, and cortisone injections are no exception.

   可的松注射到关节可以使骨关节炎症状暂时缓解。可的松是一种强大的消炎药。当注射到关节本身，可的松可以帮助缓解疼痛。疼痛缓解是暂时的，通常只持续几个星期到几个月。任何关节注射都存在很小的感染风险，可的松注射也不例外。

Surgery

手术治疗

Eventually, it may be necessary to consider surgery for OA of the ankle. There are several different types of surgery that can be performed to help with your condition. Which procedure is recommended by your surgeon will be determined by many things. These include how much the degeneration in the ankle has progressed, how active you are, how old you are, and what other medical problems you have. Each type of procedure has risks and benefits that should be discussed with your surgeon. The choices for surgery are arthroscopic surgery to clean up the joint, fusion of the joint, or replacing the joint with an artificial ankle joint.

   最终，可能需要考虑手术治疗踝关节炎。根据您的病情可以采纳几种不同类型的手术。医生给你的建议是根据许多事情来决定的。这些措施包括脚踝的善情况，你的积极程度，年龄，其他的医疗问题。每种类型的手术方式均有利弊，应与你的医生进行沟通讨论。手术的选择有关节镜手术清理关节术，关节融合术，或用人工踝关节替换术。

Arthroscopic Debridement

关节镜下清理

Sometimes when OA of the ankle occurs, loose pieces of cartilage and bone float around inside the ankle joint. These loose bodies can cause irritation in the joint, leading to inflammation. They can also get caught between the joint surfaces of the ankle. This can cause a sharp pain when it happens. The cartilage surfaces of the joint also become rough, with flaps of cartilage that peel off the surface, much like paint peeling off the ceiling. Bone spurs, or outgrowths, form around the joint and can grow larger over time. These bone spurs can rub against the soft tissues around the ankle joint when the ankle moves, again causing pain and swelling.

   脚踝关节炎发生时，有的软骨和骨的松散部分游离于踝关节内部。这些游离体可在关节造成刺激，导致炎症。它们也可以卡到踝的关节面之间。当发生这种情形时，可能会导致剧烈的疼痛。关节的软骨表面也变得粗糙，其襟翼与软骨表面剥离，很象天花板上的油漆剥落。围绕关节形成的骨刺或副产物可以随着时间的推移变得越来越大。脚踝移动时，这些骨刺摩擦到围绕在踝关节的软组织，会再次引起疼痛和肿胀。

The arthroscope can help the doctor remove these loose bodies and bone spurs and smooth the cartilage surfaces of the ankle joint. The arthroscope is a special TV camera that is inserted through small incisions (one-quarter of an inch) around the ankle. Small surgical tools can also be inserted through these incisions to work in the ankle joint.

   关节镜可以帮助医生除去这些游离体和骨刺，使得踝关节软骨表面光滑。关节镜是插入踝关节周围小切口（一英寸的四分之一）的一台特殊的电视摄象机。小外科手术工具也可以通过这些切口插入踝关节进行操作。

Related Document: A Patient’s Guide to Ankle Arthroscopy

相关文献：踝关节镜患者指南

踝关节融合术

When the ankle joint becomes so painful that it is difficult to walk, surgery may be suggested to fuse the ankle joint. An ankle fusion is sometimes also called an ankle arthrodesis. In this operation, the three bones that make up the ankle joint (the talus, the tibia, and the fibula) are allowed to grow together, or fuse, into one bone. Once this is done the ankle no longer is able to move, but with a successful fusion the pain is gone. Most people with a successful fusion of the ankle are able to walk without much trouble, and in some cases it is almost impossible to tell that the ankle is stiff. But it is very difficult to run because you lose the ability to push off with the toes. The foot can’t bend down.

   当踝关节痛的无法走路时，医生会建议手术融合踝关节。脚踝融合有时也被称为踝关节固定术。在该操作中，三块构成踝关节可以共同成长的骨头（距骨，胫骨和腓骨），或融合成一块骨。一旦这样做了，踝关节不再能够活动，但疼痛会在成功融合后消失。大多数脚踝成功融合的人给行走不会带来太多的麻烦，甚至某些病例，几乎感觉不到脚踝僵硬。但由于你失去了脚趾推地的能力，跑起来非常困难。脚不能弯曲了。

Most people will need some changes made to their shoes following an ankle fusion. Because the ankle no longer moves, it is difficult to roll over the top of the foot when you take a step. For this reason, shoes are usually fitted with a rocker sole. This allows the shoe to roll instead of the foot. A special heel is sometimes built on the shoe to absorb some of the shock.

   大多数踝关节融合术后的人需要对自己的鞋子做一些改动。因为脚踝不再活动，当你迈步前行时，想越过脚的顶部是很困难的。出于这个原因，鞋子通常装有一个滚轮鞋底。这让鞋子代替脚向前滚动。安装在鞋子上的特殊的脚后跟可以吸收一些震荡。

The ankle fusion is a good operation, especially for a young, active person. It is usually the preferred option for post-traumatic arthritis of the ankle. Once the ankle is successfully fused it can last a lifetime, and no other operations are expected later unless there are problems. But there are complications associated with the ankle fusion, and not all ankle fusions are successful.

   踝关节融合术是一个很好的操作，尤其是对于充满活力的年轻人。它通常是踝关节创伤性关节炎的优先选择。一旦脚踝成功融合，它可以持续一生，并后期不需要其他操作，除非遇到问题。但踝关节融合也有相关的并发症，不是所有的脚踝融合都是成功的。

Related Document: 

相关阅读：踝关节融合术患者指南（待翻译，有兴趣者请留言）

Artificial 

人工踝关节置换

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Because no one wants to lose the ability to move the ankle, much research has been done trying to perfect an artificial ankle replacement. Until now, the artificial ankle has not been nearly as successful as the artificial hip or knee.

   因为没有人愿意失去活动脚踝的能力，所以做了大量的研究去努力完善人工踝关节替代品。到现在为止，人造踝关节尚未与人工髋关节或膝关节那样成功。

The ankle is a difficult joint to replace for many reasons. The socket (usually called the mortise) is actually made up of two bones, the tibia and the fibula. These two bones move against one another slightly when we walk. This makes it difficult to get the artificial ankle socket to stay connected to the bone.

   引起脚踝关节替换困难的原因有很多。臼窝（通常被称为卯）实际上是由两块骨头组成的，即胫骨和腓骨。当我们行走时，这两块骨头进行轻微的相互之间的移动。这使得人造踝关节臼窝与骨相连始终异常困难。

The biggest problem with the older artificial ankle designs is that they loosened after a relatively short time and began to cause pain. When using the newer artificial ankle designs, surgeons have tried to solve this problem by actually fusing the tibia and fibula together during the operation and placing screws across the two bones. This has dramatically increased the success rate for the artificial ankle replacements done today. Many surgeons are now beginning to use the artificial ankle for post-traumatic arthritis instead of doing a fusion. Patients are able to keep the motion in the ankle and avoid some of the problems associated with the ankle fusion.

   原先的人工踝设计最大的问题在于，在相对短时间内，它们会变松并开始引起疼痛。当使用新式的人造踝设计，外科医生已经尝试通过在实际操作过程中把胫腓骨融合，并把两个骨头钉在一起来解决这个问题。这极大地增加了现在做人工踝关节置换的成功率。现在，许多医生都开始用人工踝关节治疗创伤性关节炎，而不是做融合术。患者脚踝能够保持运动和避免某些与踝关节融合相关的问题。

Related Document: 

相关阅读：人工踝关节置换术患者指南（待翻译，有兴趣者请留言）

Rehabilitation

康复

What should I expect following treatment?

   后期我还有些什么处理？

Nonsurgical Rehabilitation

非手术康复

If you don’t need surgery, range-of-motion exercises for the ankle should be started as pain eases, followed by a program of strengthening. The program advances to include strength and balance exercises. You’ll be given tips on keeping your symptoms controlled. You will probably progress to a home program within four to six weeks.

   如果你不需要手术，脚踝区间运动练习应该在疼痛减轻就开始，其次是加强计划。该计划包括力量和平衡练习。你会在如何控制症状上得到一些提示。然后可能四到六周之内发展到家庭计划。

In cases of advanced OA where surgery is called for, patients may also see a physical therapist before surgery to discuss exercises that will be used just after surgery and to begin practicing using crutches or a walker.

   外科手术强调的晚期关节炎的情况下，患者也知道术前进行物理治疗，在手术后也会用到，并开始练习使用拐杖或助行器。

After Surgery

术后康复

Your ankle will be bandaged with a well-padded dressing and a splint for support after surgery. Most patients are instructed not to place weight on their foot for a period of time after surgery. After , this period lasts about one week. After ankle joint replacement, patients usually avoid placing weight on their foot for up to 12 weeks.

   你的脚踝将用良好的填充敷料和术后的支撑夹板包扎固定。大多数患者术后的一段时间里，被要求脚上不得负重。关节镜检查后，这个时间大约持续一个星期。踝关节置换术后，患者脚通常避免负重长达12个星期。

Physical therapy sessions may be needed after surgery for up to two months. The first few treatments are used to help control the pain and swelling after surgery. Treatments include , ice, and soft tissue massage. Hands-on joint movements and stretching are used to improve range of motion and flexibility.

   手术后可能需要物理治疗长达两个月。起初的治疗用来帮助控制疼痛和手术后肿胀。治疗方法包括电疗，冰敷，软组织按摩。手动帮助关节运动和伸展用于改善活动范围和灵活度。

Therapists sometimes treat their patients in a pool. Exercising in a swimming pool puts less stress on the ankle joint, and the buoyancy lets you move and exercise easier. Once you’ve gotten your pool exercises down and the other parts of your rehab program advance, you may be instructed in an independent program.

  治疗师有时在泳池中治疗自己的病人。在游泳池锻炼，踝关节承受更小的压力，而浮力可以使您活动和锻炼更加容易。一旦你已经提前达到了你的游泳池练习和其他部分的康复计划效果，您可以接受独立项目的指导。

Your therapist will also work with you to safely progress the amount of weight you are able to place on your foot. The goal will be to help you walk comfortably and with a smooth walking pattern. Some of the exercises you’ll do are to help strengthen and stabilize the muscles around the ankle joint. You’ll be given tips on ways to do your activities while avoiding extra strain on the ankle joint.

       康复师也将与您一起安全得提高你的脚能够承受的重量。我们的目标将是帮助你达到舒适和平稳的行走模式。有些你要做的练习是帮助加强和稳定踝关节周围的肌肉。你会得到一些提示，指导你如何做你的活动，同时避免对踝关节增加额外的压力。

（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。

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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。