求翻译～外科 英译汉 Indirect Bone Healing :The Response to

求翻译～外科 英译汉 Indirect Bone Healing :The Response to
求翻译～外科
英译汉
Indirect Bone Healing :The Response to Less Rigid or Flexible Fixation
As discussed earlier, gap healing requires stable conditions, and is possible only in "quiet gaps." It is jeopardized by interfragmentary motion(i.e., when not enough preload is built up to compensate deforming forces). Small gaps are advantageous or even required for direct bone healing but can be dangerous in cases of microinstability. Microinstability indicates that small,almost invisible displacement of the fragments suffices to alter or destroy the living contents in the gap. Widening of a transverse gap under bending may surpass the strain tolerance of supporting tissues. Compression, which is even more likely to occur,will smash all invading cells and blood vessels.
The reaction to microinstability is uniform: micromovement induces bone resorption. This statement is based on clinical experience and has been proven by well-controlled animal experiments concerning the tissue reaction around screws. In case of unstable gaps,osteoclasts gather around blood vessels both at the periosteal \x0band endosteal entrances to the gap or at the contact interface and start widening it. The resulting wedgeshaped resoption may even be recognizable in radiographs. Widening of the gap reduces the strain on the cells and creates the living conditions necessary for stiffer tissue and ultimately for bone .However,undoubtedly widening of the gap by osteoclastic resorption causes a considerable delay of bone formation and consolidation. Plate and screw fixation
However，undoubtedly widening of the gap by osteoclastic resorption causes a considerable delay of bone formation and consolidation. Plate and screw fixation is particularly detrimental in this respect， since both implants act as spacers，keeping the fragments apart and preventing force transmission through the bone. This increases the load on the implants and， ultimately，the risk of failure by fatigue or loosening.
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间接骨愈合：属于骨组织在非坚固固定或者弹性固定情况下的修复反应
如前所述,骨折间隙的愈合需要在稳定条件下进行,所以这各修复只能发生在“静止的间隙”里.这种骨愈合会因为骨折断端间的动度而受到影响（例如,骨折固定的预加载不足以代偿形变力时）.骨折的小间隙是有利的甚至直接骨愈合必要前提,但若发生微小的动度则是有害的.微动度提示骨折断端的几乎不可见的微小错位足以改变甚至破坏骨折间隙里的内容物的生长.弯曲造成的间隙横向上可能超出支持组织的张力耐受.压力有时更容易发生,并会间隙内所有为修复扩张生长的细胞和血管.骨组织对微小动度的反应是一致的：微小动度引发骨吸收.这一结论来源于临床观察,并且已经被设置良好对照的研究螺钉周围的组织反应的动物实验所证实.
在不稳定的骨折间隙中,破骨细胞在骨表面和骨内部通向间隙的接触面沿血管聚集,并开始扩大间隙.这各吸收造成的角形吸收甚至可以在X线片里见到.随着间隙的扩大,细胞所受到的压力得到解除,硬组织形成的生存条件逐渐形成,并最终形成骨.然而,破骨细胞造成的骨间隙的增大必定会大幅度地延迟骨组织的形成和硬固.钛板和螺钉固定,就此而言就显得尤其得重要,这些植入体即可以保持骨折断断的间隙又可以维持固定骨折的断端并且可以阻止力量在骨内的传导.这增加了植入体的载荷,并最终会增加失败,疲劳和松动的风险.