足骰骨手术入路

足骰骨手术入路 1、适应症 Indications The dorsolateral approach is indicated for fractures of the cuboid which are displaced, and especially those fractures that have shortened. Shortening of the lateral column leads to abduction and overpronation of the forefoot. Such deformity gravely interferes normal function. 此手术入路适用于足骰骨骨折简单骨折，粉碎骨折，关节 Anatomy In order to localize your incision, palpate the following anatomical points. The sinus tarsi and distal calcaneus are palpable proximally. The base of 4th and 5th metatarsal are palpable distally. The cuboid lies between those two areas. 为了确定手术切口位置，需要触及以下解剖标志:1.跗骨窦和跟骨近端;2.第4、5跖骨基 底。骰骨位于这两个解剖之间。 The sural nerve which lies in the subcutaneous tissues branches in this area with dorsolateral and lateral branches. Care should be taken not to harm these. The extensor digitorumbrevis (EDB) muscle belly overlies the cuboid dorsolaterally. The peroneal tendons traverse from superior lateral to inferior lateral. The peroneus longus (PL) traverses inferiorly through the cuboid groove towards its insertion on the plantar base of the first metatarsal. The peroneus brevis tendon inserts into the base of the 5th metatarsal with the occasional peroneus tertius. 腓肠神经的背外侧分支和外侧分支位于皮下，避免损失。 趾短伸肌肌腹位于骰骨背外侧，腓骨肌腱从上外侧至下外侧;腓骨长肌横行从骰骨下方穿 过止于第1跖骨基底;腓骨短肌与第3腓骨肌止于第1跖骨基底。 3、皮肤切口 Skin incision The incision begins approximately 1 cm inferior to the sinus tarsi and overlies the distal superior calcaneal prominence. It is an axial incision and proceeds along a straight line towards the lateral base of the fourth metatarsal. It can be extended proximally to access to the sinus tarsi and the distal calcaneus, if it is fractured. Distally the incision can be extended to address cuboid and the 4th and 5th metatarsal pathology. 皮肤切口位于第3腓骨肌近端1cm处向后延伸至跟骨，与第4跖骨基底平行。 切口可以向两端延伸。 4、保护腓肠神经 Protect sural nerve The sural nerve branches in this area with dorsolateral and lateral branches. Care should be taken not to harm these. 腓肠神经在这个区域有背外侧和外侧分支，注意保护。 5、深层分离 Deep dissection The extensor digitorumbrevis (EDB) muscle belly is then reflected dorsomedially. The peroneallongus muscle belly crosses from superior laterally and goes under the cuboid in the peroneal groove on its course to the plantar base of the first metatarsal. The peroneus brevis inserts onto the base of the fifth metatarsal. The peroneals can be retracted proximally and inferiorly. The cuboid is then exposed. Distraction pins can be placed in the distal lateral calcaneus and proximal metaphyseal 4th and 5th metatarsals. The calcaneal cuboid and cuboid-4,5 metatarsal joints are also exposed. 伸趾短肌肌腹牵向背内侧，腓骨长肌肌腹从上外侧走至骰骨下方止于第1跖骨基底，腓骨 短肌止于第5跖骨基底，牵开腓骨肌，显露足骰骨。同时显露骰跟关节和骰第4、5跖骨关 节。