Episode Transcript
Dr. Miller: 你扭伤了脚踝，会不会骨折，该怎么办? I'm Dr. Tom Miller in here with Scope Radio.
Difference Between an Ankle Fracture and a Sprained Ankle
Dr. Miller: I'm here today with Dr. Alexej Barg，他是犹他大学的整形外科医生. He specializes in foot and ankle problems. Alexej, 踝关节扭伤是非常常见的，经常发生在青少年和儿童进行运动. 在扭伤脚踝后，在什么情况下应该接受额外的治疗，以确保脚踝没有骨折?
我认为这是我在实践中看到的一个典型问题. People come in, they sprain their ankles and they want to know, "Well, could I have fractured the ankle?"
Most Common Sports Injuries
Dr. Barg: 在美国，脚踝扭伤无疑是最常见的伤害. This is actually also the most common sports injury. 在急诊室就诊的患者中，每10人中就有1人以上是因为脚踝扭伤而来的. Of course, 你不能对每个病人都这么做而不去看这个病人, just the routine radiograph assessment.
In the last case, 有一些临床研究探讨了疗效或是否需要做x光片. I don't think those guidelines are good. However, 病人是否需要x光片还取决于主治医生或整形外科医生. In my experience, if it's just a mild sprain, especially in the younger kids or teenager, there's definitely no need to do immediately radiographs.
Dr. Miller: What does a mild sprain look like to you?
What Is a Mild Ankle Sprain?
Dr. Barg: 例如，对我来说，轻微的扭伤总是只发生在侧面. That means on the outside, not the inside. 通常，它只是轻微的小，病人仍然可以去承重. [听不清00:01:53]一种疼痛或者仅仅是疼痛，不一定是疼痛. 内侧没有肿胀，内侧没有. This is for me the mild sore.
如果病人有肿胀和血肿, that means some color change, on the medial and/or lateral side, 肯定需要表演或者做x光片, the X-rays to exclude a bone fracture.
Dr. Miller: 如果脚踝扭伤后他们无法承受重量怎么办? Does that make a difference? I've heard that sometimes, 如果扭伤脚踝的人在受伤后的一段时间内不能把重心放在脚上, they should receive an X-ray.
Dr. Barg: 通常，在受伤后，几乎每个踝关节扭伤的人都无法承受重量. I would definitely wait a couple hours. Usually, 这些患者在受伤后4到6小时内疼痛得到了明显缓解, especially if they do elevate the foot, if you do the cooling of the injured ankle.
如果他们在六个小时后仍然感到非常剧烈的疼痛，那么他们根本无法在上面行走, 绝对有需要做x光片的迹象. 另一个问题是，如果病人在受伤后两到三周仍感到疼痛, it doesn't matter whether it was a mild injury, they need an x-ray. 他们应该去诊所，首先，整形外科医生应该检查一下.
It can be a foot and ankle surgeon, 也可以是有运动损伤经验的人或同事，然后, finally, 大发娱乐将决定这个人是否需要x光片.
Dr. Miller: 问你一个问题，脚踝扭伤的伤通常是内伤还是外伤? Medial or lateral on the foot?
Dr. Barg: Most likely, it is on the lateral side. 在侧面，大发娱乐实际上有三条韧带尤其是前韧带. That means that the ligament in the front. 这是一个非常薄的韧带，几乎大发娱乐每个人都已经伤过了. Fortunately, 他们确实痊愈得很好，我想说只有5%的患者踝关节外侧扭伤, that means the sprain on the outside, 他们会发展成需要治疗的慢性不稳定.
That is different on the medial side. 幸运的是，内侧受伤非常罕见. They are not as often than on the lateral side. However, most likely, the patient with the severe sprain of the medial ligaments, that means on the inner side, 他们后来确实发展成慢性不稳定，需要手术治疗.
Dr. Miller: After an ankle sprain, we determine it's not a fracture. What are the sorts of things that a patient can do, a person can do to eliminate the discomfort, the swelling and then get back in the game, so to speak?
Dr. Barg: 通常，我把脚踝扭伤的严重程度分为四个等级. 就像一年级是轻微的扭伤，四年级肯定是严重的扭伤. 轻度扭伤，轻度扭伤的病人不需要特殊的治疗. They can [below] the ankle if it's comfortable for them.
Usually, we can start with physical therapy pretty quickly and the physical therapy, the main of the physical therapy is the first main, is to decrease the local swelling. 第二个主要是所谓的适当的[听不清00:05:20]练习. 适当的[听不清00:05:22]锻炼会起作用，这意味着理疗师可以教病人如何更好地控制脚踝.
Again, if the sprain is more severe, for example, 当我感觉所有的外侧韧带都撕裂了，甚至那些内侧韧带也可能受损, in those patients, I recommend immobilization in a boot, for example, six weeks with only partial weight bearing. 在这段时间里，大发娱乐只是试图给韧带愈合的机会，时间来愈合. Exactly.
Dr. Miller: What I'm hearing is if a person has an ankle sprain, number one, look to see if there's discoloration. So anything that looks like blood beneath the skin. By discoloration, you mean black and blue?
Dr. Barg: Yes, and I do mean exactly this.
When Do I Get an X-Ray?
Dr. Miller: 你可能需要拍x光片，或者应该拍x光片，并寻求关注. If you can't weight bear immediately after, that doesn't necessarily mean that you have a fracture, but if that persists beyond a day or 12 hours to a day, then you probably need an X-ray. 即使是轻微的扭伤，几周后你仍然在与疼痛作斗争, 然后你需要寻求关注并拍x光片以确保你没有骨折.
Dr. Barg: Yes, absolutely. Another specific situation in this patient group is, for example, again, 这个群体中95%的人在没有任何限制的情况下长期痊愈. However, those five percent, they still have, for example, four, six months after the initial injury, 他们仍然会有脚踝疼痛，尤其是不稳定的感觉. 特别是当病人试图在不平坦的地面上行走时. 这些患者需要去看医生，看看他们是否需要治疗脚踝不稳定.
updated: October 28, 2020
originally published: September 9, 2015