距骨骨折手术入路----前内入路完整版.docxVIP

Indications???指征 The anteromedial approach is usually employed in combination with the anterolateral approach in order to obtain an anatomic reduction of displaced and comminuted fractures. 前内入路通常与前外入路联合应用，以便对距骨获得解剖复位。 In the less common situation where the fracture of the talar neck is not comminuted, one can obtain an anatomic reduction and fixation using only the anteromedial approach. 少数情况下，当距骨颈不是粉碎骨折，可以使用单纯前内入路获得解剖复位和固定。 ? ? ? ? ? ? ? ? ? Anatomy???解剖 One must not damage the blood supply to the talus. The neck of the talus receives branches from the medial and lateral side. The body of the talus is supplied almost exclusively from its posteromedial aspect. 必须避免损伤距骨血供，距骨颈血运来自内侧和外侧面，距骨体则由后正中单独供应。? ? ? ? ? ? ? ? ? ? ? The anteromedial approach avoids these two neurovascular bundles and provides access to the medial talus and surrounding joints. 入路应避免两个神经血管束（隐神经大隐静脉束/胫后神经血管束），?显露距骨内侧和周围关节 ? ? ? ? ? ? ? ? ? ? ? Skin incision???皮肤切口 This incision runs from the medial malleolus proximally to the base of the first metatarsal distally. For more complex fractures the incision may be extended proximally. ?切口起自内踝下级至第一跖骨基底。多数复杂骨折可能需要显露下极。 ? ? ? ? ? ? ? ? ? It is most important not to damage the deltoid branches which arise posteromedially and supply the medial two thirds of the talar body. ?不要损伤从后内侧分出供应距骨体2/3部分血管分支。 ? ? ? ? ? ? ? ? ? ? Exposure of the anteromedial talar neck 显露前内侧距骨颈 Once skin and fascia are incised, one encounters the fracture hematoma which should be evacuated in order to expose the underlying infero-medial aspect of the neck, and the fracture. 切开皮肤和筋膜后，清除骨折端血肿，显露下面距骨颈下内侧面和骨折。 The arrow points to a simple fracture of the talar neck, which is less common. ?下图显示个简单距骨颈骨折，这个损伤很少见。 ? ? ? ? ? Debridement of subtalar joint????切开距下关节 The fractures on the medial side are often multifragmentary. Fragments which are displaced into the subtalar joint must be debrided to allow an anatomic reduction of the subtalar joint. 内侧面骨折都通常都是复杂骨折，骨折块落入距下关节必须被清除，以便解剖复位距下关节。Rest