距骨骨折手术入路---前外侧入路

Indications

适应症：

The anterolateral approach is usually employed in combination with the anteromedial approach to gain access to any displaced talar neck fracture.

前外侧切口通常于前内侧切口联合应用以充分显露距骨颈。

However, for certain fractures such as minimally displaced fractures or very simple neck fractures, it can be used as the sole approach.

然而，当骨折明确如无明显移位骨折或简单距骨颈骨折，也可以单独使用前外侧入路。

Anatomy 解剖

Around the ankle and hindfoot, full-thickness incisions without undermining are imperative. To avoid cutting the branches of the superficial peroneal nerve, most of the incisions must be made in a longitudinal direction.

在踝关节和后足，必须用全厚层皮瓣切口。为避免切断腓浅神经，切口需要设计纵轴方向。

The superficial peroneal nerve lies in the incision or very near and must be avoided and protected.

腓浅神经多位于手术切口附件，必须注意保护。

Incision 切口

Skin incision 皮肤切口

The incisions here are based on the deep talar anatomy which lies underneath the extensor digitorum brevis.

The incision is based on the fourth metatarsal and lines up with this bone.

切口与其下的解剖相关，伸趾短肌位于下方，与第4跖骨平行。

Deep dissection 深层分离

The muscle of extensor digitorum brevis is bulky but once this muscle is split, one gains access to the lateral talus and subtalar joint.

伸趾短肌体积明显，但是，一旦分离此肌肉，距骨外侧和距下关节就看到距骨前外侧和距下关节了

Exposure of the anterolateral talar neck

显露前外侧距骨颈

Once the extensor digitorum brevis is split longitudinally and retracted, one exposes the lateral aspect of the talar neck。

当伸趾短肌被牵开，距骨颈就显露出来了。

Most talar neck fractures result from a medially directed force. Therefore, the lateral side of the neck comes under tension and the medial side under compression. The fractures on the lateral side are simple, and on the medial side multifragmentary. Exposure from the medial side alone runs the risk of shortening the neck and

malreducing the fracture. To ensure an anatomic reduction, fractures of the neck must be exposed from the lateral and medial side.

多数距骨颈骨折是由于内侧直接暴力引起。因此，距骨颈外侧面承受张力，而内侧面承受压力。所有，外侧面骨折多是简单骨折，内侧面骨折多粉碎骨折。单纯显露内侧面有引起距骨颈短缩，和引起骨折复位不良。为了达到解剖复位，颈部骨折必须暴露外侧和内侧面。

The arrow on the image indicates a simple fracture of the talar neck.下图的箭头显示距骨颈简单骨折

Debridement of subtalar joint 复位距下关节

Debridement of the subtalar joint is imperative to facilitate an excellent reduction.

距下关节必须得到很好的复位。

Using both anterolateral and anteromedial approaches provides

excellent access to the whole talar neck. The importance of this lies in getting a perfect reduction for definitive fixation.

同时使用前外和前内切口可以提供足够距骨颈的显露，并可以在很好的复位和固定。

Our CT image shows comminution of the inferior talus.

CT显示距下关节粉碎骨折