英汉对照骨科患者指南031：腓骨肌腱疾病（下）

Peroneal Tendon

腓骨肌腱

A Patient’s Guide to Peroneal Tendon Problems

腓骨肌腱病变患者指南

Treatment

治疗

What can be done for the problem?

　　对于这些问题需要怎样处理？

Nonsurgical treatment for peroneal tendon problems helps control symptoms. Surgery is usually not considered until it has become impossible to control the symptoms without it.

　　腓骨肌腱疾患通过保守治疗有助于控制症状。除非保守治疗不能控制症状，通常不考虑外科手术。

Nonsurgical Treatment

保守治疗

Initial treatments may involve resting and protecting the sore tendons. You may need to immobilize your foot and lower leg in a a short-leg walking boot for two to four weeks. In less severe cases, you may use a stirrup ankle brace, arch support, or lateral heel wedge to take tension off the sore tendons.

　　初始的治疗包括休息和保护受伤的肌腱。你需要穿短腿行走靴2~4周来制动你的足和小腿。在不严重的病例中，你可以应用马镫脚踝支具、足弓垫、或后跟外侧楔以消除受伤肌腱的张力。

You will probably work with a physical therapist. The therapist may use heat, ice, and ultrasound treatments to reduce pain and swelling. Stretching, strengthening, and ankle coordination exercises are added as symptoms ease.

　　你需要配合理疗师的工作，理疗师会用热疗、冷敷和超声治疗来减轻疼痛和肿胀。一旦症状缓解，就需要增加伸展活动、力量训练和踝关节协调性练习。

Your doctor may also prescribe medications. Anti-inflammatory medications can help ease pain and swelling and get you back to activity sooner. These medications include common over-the-counter drugs such as ibuprofen.

　　你的医生也可能会给你开具药物。消炎药可以帮助缓解疼痛和肿胀，使你能更快地重返运动。这些药物包括普通的非处方药物比如布洛芬。

In rare cases, cortisone can be injected into the sore tendons to relieve symptoms that won’t go away. Cortisone is a powerful anti-inflammatory medication. Because there is a risk that cortisone will cause a tendon to rupture, doctors are very cautious about injecting cortisone into the peroneal tendons.

　　极少数病例中，若症状不能缓解可将考的松注射到受伤的肌腱周围来缓解症状。考的松是一种强效的消炎药物。因为考的松有引起肌腱断裂的风险，医生对腓骨肌腱采用注射考的松治疗会非常谨慎。

Surgery

手术

Tendon Release

肌腱松解术

When the lining of the tendon is painful and inflamed (as in tenosynovitis), the goal of surgery is to remove the irritated tissue from around the tendon. This operation is called tendon release. This procedure is done by carefully dividing the tendon sheath that encloses the tendon. Once the sheath is opened, the surgeon clears away the irritated tissues around the tendon. The sheath is not stitched back together. The gap in the sheath will eventually fill in with scar tissue. The skin is closed with sutures.

　　当肌腱的腱鞘疼痛并有炎症时（比方说腱鞘炎），外科手术的目的是切除包裹着肌腱的炎症粘连组织。这类手术叫做肌腱松解术。手术是通过仔细分离包裹肌腱的腱鞘组织来完成。一旦腱鞘被打开，外科医生清除包绕着肌腱的炎症粘连组织。打开的腱鞘不再缝合回去。腱鞘上的缝最终被疤痕组织所充填。皮肤切口用缝线关闭。

Debridement

清创术

The procedure for surgically treating tendinosis is similar to the method used for tenosynovitis. However, extra measures are taken to thoroughly remove (debride) the degenerated tissue around and within the involved tendon.

　　外科治疗肌腱变性的方式类似于外科治疗腱鞘炎的方式。然而略有不同的是，治疗肌腱变性时需彻底拿掉（清除）包裹肌腱和受累肌腱内部的退变组织。

Tendon Repair

肌腱修补术

Tendinosis may require repair if a preoneal tendon is split down its length. This type of tear mainly affects the peroneus brevis. The surgeon fixes this problem by first dividing the sheath around the tendons. If the split is smaller than one-third the width of the tendon, the torn portion may simply be removed. Larger splits are sutured along the length of the tendon. The tendon sheath is repaired, and the skin is closed with sutures.

　　如果腓骨肌腱变性致纵向劈裂的话需要修补。这种纵向撕裂的类型主要发生在腓骨短肌肌腱上。外科医生治疗这种状况首先切开分离包绕肌腱的腱鞘。如果裂开小于肌腱三分之一的宽度，那么撕裂部分可以单纯切除。再大一点的撕裂可以沿着肌腱长度作缝合。切开的腱鞘缝回去，皮肤用缝线关闭。

Rehabilitation

康复

What should I expect following treatment?

　　治疗后我还需要做些什么？

Nonsurgical Rehabilitation

保守治疗后的康复

Even if you don’t need surgery, you may need to follow a program of rehabilitation exercises. Your doctor may recommend that you work with a physical therapist. Your therapist can create a program to help you regain normal ankle function. It is very important to improve strength and coordination in the ankle.

　　即便你不需要手术治疗，接下来你可能仍需要做康复训练。你的医生会建议你跟着物理治疗师做。你的物理治疗师会为你制定康复计划来帮助你恢复正常踝关节功能。这对于改善踝关节的力量和协调性是非常重要的。

After Surgery

术后康复

Patients are usually placed in a short-leg  for four to six weeks after surgery. A special walking boot is worn for another four weeks. Patients usually take part in formal physical therapy once the cast is removed. Rehabilitation after surgery can be a slow process. You will probably need to attend therapy sessions for one to two months, and you should expect full recovery to take up to four months.

　　手术后病人通常用短腿石膏保护4至6周。然后换穿特制的行走靴4周。一旦石膏去除病人通常即可参加正规的物理治疗。外科术后的康复是个缓慢的过程。你可能需要参加理疗达1至2个月时间，预计完全康复总共需4个月时间。

The first few physical therapy treatments are designed to help control pain and swelling from the surgery. Ice and  treatments may be used during your first few therapy sessions. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain. Treatments are also used to help improve ankle range of motion without putting too much strain on the healing tendons.

　　术后早期物理治疗主要是控制术后的疼痛和肿胀。冷敷和电刺激治疗在术后早期被应用。你的治疗师也运用按摩和其他手法治疗来缓解肌肉痉挛和疼痛。治疗也有助于改善踝关节活动度，并且不会给正在愈合的肌腱带来太多的拉力。

After about four weeks you may start doing more active exercise. Exercises are added slowly to improve the strength in the peroneal muscles. Your therapist will also help you regain position sense in the  to improve its overall stability.

　　大约4周后你可以开始做更加积极的锻炼，慢慢增加练习量以提高腓骨肌的力量。你的物理治疗师也将帮助你的踝关节恢复位置觉，提高踝关节整体稳定性。

The physical therapist’s goal is to help you keep your pain under control, improve your range of motion, and maximize strength and control in your ankle. When you are well under way, regular visits to the therapist’s office will end. Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.

　　物理治疗师的目的是帮助你使得疼痛在可控范围之内，改善你踝关节的活动度，强化你踝关节的力量和控制力。当你开始很好地进行康复时，定期到理疗师办公室去造访就可以告一段落了。你的理疗师将继续作为一个你康复理疗指导的资源，但是你将自主进行康复训练并将其作为后续家庭训练计划的一部分。

（沈是铭　译）

沈是铭，主任医师，宁波市镇海龙赛医院副书记、副院长，硕士。浙江医科大学第一届临床医学七年制，浙医大附属第二医院骨科毕业。宁波市领军和拔尖人才第二层次，宁波市医学会骨科分会委员。镇海区121人才第一层次，镇海区学科带头人。2015年获镇海区优秀人才奖。曾在香港威尔逊亲王医院矫形外科、奥地利维也纳盖尔斯特侯夫骨科医院进修学习。擅长复杂危重的骨科创伤救治与后期修复重建，及足踝外科领域疾病的诊治。