跟骨扩大外侧入路.docVIP

跟骨扩大外侧入路Extended lateral to calcaneus?? 2011-11-19 13:16:38|??分类： 手术入路 |??标签： |举报 |字号大中小?订阅 Indications 适应症 ? ???? ?? The extended lateral approach to the calcaneus is the most common approach used for displaced intraarticular calcaneal fractures. Over 90% of calcaneal fractures with displaced joint fragments can be serviced by this approach.The calcaneus can present with an enormous variety of fracture configurations. However, this approach, used with care, is the safest and most utilitarian. ???????? 最常用最安全最实用几乎适用于所有类型的跟骨骨折。 Anatomy 解剖 Vascular supply?? 血供??????? It is essential to understand the vascular supply to the subcutaneous tissues of the lateral hindfoot as wound-healing complications are common after using this approach. The perforating branches of the peroneal artery contribute to the vascularity of the lateral skin and soft tissue of the foot. The undermining of skin edges runs the risk of skin edge necrosis and therefore full-thickness flaps have to be developed to prevent this complication. 腓骨动脉分支营养足外侧的皮肤及软组织，破坏皮肤边缘的血运，有皮缘坏死的风险，全厚层皮瓣可以有效的预防这种并发症。 ??????? The lateral calcaneal artery is responsible for the majority of the blood supply to the corner of the L-shaped flap of this approach. The heel pad is mostly supplied from the posterior tibial artery branches medially.The sural nerve needs to be protected in the horizontal part of the approach. 跟骨外侧动脉（腓骨动脉分支）主要供应L型皮瓣，下方的足跟垫主要胫骨后动脉分支供应。外侧皮神经紧贴外踝下方平行向前走形，切开过程中应该注意保护。 ? ? Ligaments and tendons? 韧带和肌腱The peroneal tendons are on the lateral side of the calcaneus. Note the position of the retinaculum and of the fibulocalcaneal and talocalcaneal ligaments.In raising the full-thickness L-shaped flap, one detaches the retinacular attachment as well as that of the fibulocalcaneal and talocalcaneal ligaments from bone. 腓骨长短肌腱走形于跟骨外侧，注意踝关节外侧韧带（腓跟韧带、距跟韧带），掀起皮瓣后，注意把韧带从跟骨上分离出来。 ? Timing of surgery 手术时间的选择 ?????? Correct timing of surgery is the most important factor in preventing local wound complication. Ea