距骨手术入路----内踝截骨术.docx

1、Indications?? 指征An osteotomy of the medial malleolus exposes the medial aspect of the body of the talus and allows the surgeon to protect the posteromedial deltoid branches from the posterior tibial artery which is the main blood supply to the body of the talus.This approach is used to expose an irreducible fracture dislocation of the talus as well as fractures of the body of the talus and complex fractures of the neck with posterior extensions.内踝截骨可以显露距骨体内侧并可保护胫骨后动脉后内侧三角分支（这是距骨体主要血液供应）。此入路通常显露距骨骨折伴脱位复位困难，距骨体骨折和距骨颈粉碎骨折。??????????Anatomy??解剖The blood supply to the body of the talus is complex. Most of the blood supply to the body is through the deltoid branches of the posterior tibial artery. The dorsalispedis and peroneal artery supply the neck and the lateral third. Fracture dislocations can easily compromise the blood supply to the body of the talus and lead to avascular necrosis.距骨体血运是复杂的，大部分的血运来自胫后动脉后侧分支，足背动脉和腓动脉供应颈部和外侧1/3，骨折并脱位很容易并发距骨体血液供应障碍并引起距骨坏死。?????????Note the deltoid branches of the posterior tibial artery and the artery of the tarsal canal. A posteromedial approach to the body of the talus would destroy its blood supply. Therefore, if the body has to be exposed, one utilizes an osteotomy of the medial malleolus.注意胫后动脉分支、跗骨分支，距骨体后内侧入路可能破坏血运。因此，如果不得不显露体部，可以利用内踝截骨。??????Blood supply to the talusThe deltoid branches are important to supply blood to the medial talar neck and talar body. Branches from the dorsalispedis supply the talar head and most of the dorsal talar neck. The artery of the tarsal canal coming from branches off of the posterior tibial artery supply most of the talar body.The peroneal artery has the least contribution laterally.三角分支是内侧距骨颈和距骨体的重要血供。足背动脉（胫前动脉）供应距骨头和大部分距骨颈，胫骨后动漫供应大部分距骨体。腓动脉供应距骨外侧。?????????IncisionSkin incision??????皮肤切口This incision follows from the medial malleolus proximally to the base of the first metatarsal distally. Only that portion needed is used, but is often extended proximally for more complex fractures.Importantly