足舟骨内侧可扩展入路

1、适应证 IndicationsThemedialutilityincisioncanbeusedtoapproachanyofthemedialstructuresofthefoot,includingtendons,jointsandbones.Theincisioncanpotentiallyextendfromthegreattoealongthemedialcolumntothebackofthetalus.Mostoften,weuseonlyaportionoftheoveraillengthofthisapproach.内侧实用切口可用于足内侧结构包括肌腱、关节和骨；切口可以向远端延伸至第1趾骨，向近端可延伸至距骨。通常我们仅仅使用这个切口的一部分。2、解剖AnatomyThemedialutilityincisionisinasafeplanebetweentheposteriortibialisandtheanteriortibialis.Therearenomajorneurovascularstructuresinthisregion.Superficialsmallveinscanbecauterizedduringtheapproach.此切口位于胫骨前肌和胫骨后肌之间，此区域没有重要神经血管组织，注意浅静脉保护。

■Iy:LateralplantararteryandnervePosteriortibiolartery ■Iy:LateralplantararteryandnervePosteriortibiolartery cafcanealbranchoftibialnervePosteriorTibialtendon Anteriortibialtendon ReAordigitorumlangue Extensorhalluci^加gus 、Superficialbranchof、 .-丿medialplantardrtery\ 舟plantarartery^rtdnerveMASTERKNOTOFHENRY/ /FlexorhallucisIongus〔.Posteriortibialartery 胫后动脉Medialcalcanealbranchoftibialnerve胫神经跟骨内侧分支Posteriortibialtendon 胫后肌腱Anteriortibialtendon 胫前肌腱flexordigitorumlongus 屈趾长肌Extensorhallucislongus 伸拇长肌7.SuperficialbranchofmedialplantararteryMedialplantararteryandnerveMaterknotofhenry 屈趾长肌和屈拇长肌肌腱交叉处Flexorharllucislongus11丄ateralplanterarteryandnerve3、皮肤切口SkinincisionForthemedialapproachtothenavicular,theareaalongthemedialutilityincisionoverthenavicularisused.Theincisioncanbeextendedproximallytoallowaccesstothetalonavicularjoint,ordistallyforaccesstothecuneiforms,firstmetatarsalbaseandnaviculo-cuneiformandintertarsaljoints.内踝下至距舟关节至舟楔关节至第1跖骨基底。Theanteriortibialistendoncanbefoundatitsinsertiononthemedialcuneiformorthebaseofthefirstmetatarsal.ThemasterknotofHenrycanbefoundplantartothecuneiform,wheretheflexordigitorumIongus(FDL)andflexorhallucislongus(FHL)cross.切开可见胫前肌止于内侧楔骨或第1跖骨基底，Henry结位于楔骨处(屈趾长肌和屈拇长肌肌腱交叉处)4、背内侧切口AdditionaldorsomedialincisionIfthereisanavicularfracturewithcomminutionandlossofthearchitectureofthenavicularpartofthetalo-navicularjoint,thenadorsomedialincisionmaybeusedtoproperlyreconstructtheshapeofthenavicular.Iffracturecarerequiresamoreextensileapproach,theadvantagesofbetter

reductionarebalaneedagainstwiderdissectioncausingstripping/lossofbloodsupplywhichmayimpedehealing.Ifthedorsomedialapproachisrequired,careshouldbetakentominimizedissection.详细见足舟骨背内侧切口专题MedialdorsalCLitaneousnerveDeepfibulartie『甘乜AnteriortibialarteryExtensorhallucisiongusIntermediatedorsaltutaneou5nerveTibi詁唇anteriortendon5、关闭死腔ClosingthedeadspaceThemedialutilityincisioncanbeclosedinlayers.Afewdeepstitchesherecanclosetheplantarmedialspacethatmayhaveresultedfromthedissection,especiallywhe