距骨骨折手术入路----外侧直切口

Indications 指征

The indication for this approach is a simple fracture of the lateral process of the talus, or to debride the subtalar joint.

此手术入路适合距骨外侧突简单骨折，或清理距下关节。

This approach utilizes a simple window to approach fractures of the lateral process of the talus (e.g. “snowboarder’s talus”). Limited subtalar visualization with arthroscopy or fusion procedures can also utilize this direct lateral approach.

此入路利用简单开窗技术来显露外侧突的骨折块，例如（snowboarder’s talus），使用关节镜或距下关节融合也可用外侧切口入路。

Debridement of subchondral debris after a fracture of the subtalar joint is also an indication for this approach.

Case by courtesy of Dr. Steven Steinlauf, Florida, USA.

此手术入路也可用于清除距下关节骨折碎片

Anatomy 解剖

There are few important structures in this area. Note the peroneal tendons posteriorly and laterally, and the extensor tendons more anteriorly and dorsally. Between these two tendons is a fat pad which leads one to the subtalar joint.

此区域有些重要组织需要注意。腓骨肌腱位于后外侧，伸肌腱位于前背侧，在这些肌腱间有脂肪垫，它位于距下关节上。

Incision 切口

Skin incision 皮肤切口

This incision is placed with the help of image intensification running somewhat parallel to the tendons.

这个切口应在CT的引导下与腓骨肌腱平行切开。

It is placed closer to the peroneal tendons, centered on the lateral process of the talus and immediately in front of the fibula.

由于此切口与腓骨肌腱距离很近，在距骨外侧突中央，在腓骨下方。

Deep dissection 深层分离

Once through deep fascia, an area of fat is found which is incised revealing the subtalar capsule and the bony lateral process of talus.

当打开深筋膜，显露脂肪垫，其下方距骨窦，距骨外侧突

This provides access for treatment of the lateral process or debridement of the subtalar joint as required.

此入路提供治疗距骨外侧突骨折或距下关节清理需要。

Case by courtesy of Dr. Steven Steinlauf, Florida, USA.