足骰骨手术入路.docx

1、适应症 IndicationsThe dorsolateral approach is in dicated for fractures of the cuboid which are displaced, and especially those fractures that have shorte ned. Shorte ning of the lateral colum n leads to abducti on and overpr on ati on of the forefoot. Such deformity gravely in terferes n ormal fun cti on.此手术入路适用于足骰骨骨折简单骨折，粉碎骨折，关节内骨折，特别是短缩骨折，因为 外侧柱短缩导致外展和旋前畸形，这种畸形将影响足部正常功能2、解剖 AnatomyIn order to localize your in cisi on, palpate the follo wing an atomical poin ts.The sinus tarsi and distal calca neus are palpable proximally. The base of 4th and 5th metatarsal are palpable distally. The cuboid lies betwee n 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 n erve which lies in the subcuta neous tissues bra nches in this area with dorsolateral and lateral bra nches. Care should be take n not to harm these. The exte nsor digitorum brevis (EDB) muscle belly overlies the cuboid dorsolaterally. The per on eal tendons traverse from superior lateral to inf erior lateral. The per on eus lon gus (PL) traverses inf eriorly through the cuboid groove towards its insertion on the plantar base of the first metatarsal. The per on eus brevis tendon in serts into the base of the 5th metatarsal with the occasi onal per on eus 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Sural nervePeroneal lortgus tendon^erone^l brevis tendonPeroneus tertsus7Extend digitorum brevb (EDS)Superficial peronealnerve3、皮肤切口 Skin incisionThe in cisi on beg ins approximately 1 cm inf erior to the sinus tarsi and overlies the distal superior calca neal pro minen ce. It is an axial in cisi on 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 calca neus, if it is fractured. Distally the in cisi on can be exte nded 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 nerveThe sural nerve branches in this area with dorsolateral and lateral branches.Care should be take n 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Superficial — peraneaJ nervePeroneal longus tendonPeroneal brevis tendonBran ch of sural nerve / -CAUTION!心PeroneusExtensor digftorum brevis (EDS)5、深层分离 Deep dissectionThe exte nsor digitorum brevis (EDB) muscle belly is the n reflected dorsomedially. The per on eal l on gus muscle belly crosses from superior laterally and goes un der the cuboid in the per on eal groove on its course to the pla ntar base of the first metatarsal. The per on eus brevis in serts onto the base of the fifth metatarsal. The per on eals can be retracted proximally and in feriorly. The cuboid is the n exposed.Distractio n pi ns can be placed in the distal lateral calca neus and proximal metaphyseal 4th and 5th metatarsals.The calca neal 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li! I,jExtensor digitorum f brevis (EDB)Branch of sural nerve /。