足舟骨背侧入路.docx

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1、1、适应症 IndicationsThedorsomedialapproachtothenavicularcanbeusedforcomminuted,displaced,intraarticularfractures. Thetalo-navicularjointisveryimportant.Lossofthetalo-navicularjointcanresultinlossof90%orgreaterofcomplexhindfootmotion/circumduction. Iffracturecarerequiresamoreextensileappr

2、oach,theadvantagesofbetterreductionarebalancedagainstwiderdissectioncausingstripping/lossofbloodsupplywhichmayimpedehealing.Ifthedorsomedialapproachisrequired,careshouldbetakentominimizedissection. Theapproachcanbeextendedontothedistaltalus.Asmalldistractorcanbeused.Thisallowsvisualiz

3、ationandpalpationoftheconcavityofthenaviculartoassureanatomicalreduction.适用于足舟骨粉碎脱位关节内骨折，距舟关节非常重要，失去距舟关节，将失去90%后足活动。避免广泛皮下剥离，防止发生皮肤坏死。此切口可以延伸至距骨，可在直视下复位骨折块。 2、解剖   Anatomy     Thedorsomedialapproachtothenavicularismadebetweenthetibialisanteriortendonandextensorhallucislongus(EHL)tendo

4、n.Theapproachshouldbemadestraightdownfromskintoperiosteumwithoutraisingflapsoranyunnecessarydissection.     Asmalldistractorcanbeusedtoaidinmedialcolumnalignment/lengthandtoallowvisualizationandpalpationofthetalonavicularjoint.Oncereconstruction,bonegrafting(ifneeded)andprovisionalfix

5、ationareaccomplished,adorsalplatecanbeapplied.     Ifneeded,thenavicularreconstructioncanincludebridgeplatingandscrewfixationintothecuneiforms.     背内侧切口位于胫骨前肌和拇长伸肌腱之间，直接经皮切开至骨膜，不要分离皮瓣。  3、皮肤切口SkinincisionTheincisionusestheintervalbetweenthetibialisanteriorandtheEHL,roughlydirectlyove

6、rthefracture. 背内侧切口位于胫骨前肌和拇长伸肌腱之间，舟骨上方。   Theincisioncanbeextendeddistallyifincorporationofthecuneiformsintotheconstructisneeded. Theincisioncanbeextendedproximallytoallowinspectionandpalpationofthetalonavicularjoint.切口可以向远端延伸，如果楔骨有骨折的话，也可向近端延伸探查距舟关节。4、深层分离DeepdissectionOncedowntothep

7、eriosteum/jointcapsule,thetibialisanteriorcanberetractedmediallyandtheEHLcanberetractedlaterally.Thiswillexposethedorsumofthenavicular.切开至骨膜或关节囊后，将胫前肌向内侧牵开，将拇长伸肌腱向外侧牵开，显露舟骨背侧。 5、直视关节  VisualizationofthejointInahigh-energyinjury,thecomminutionmaybesevere.Careshouldbetakennottostripthep

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