transankle lateral fusion

The lateral fusion is divided into the anterior border of the humerus and the posterior border of the humerus. There is a saw blade pneumatic saw device, and the anterior approach of the humerus is simpler. The lateral ankle joint fusion is suitable for ankle joint tuberculosis. The incision is more exposed than the anterior approach, the lesion is completely removed, and the fusion fixation is relatively firm. Treatment of diseases: ankle joint tuberculosis Indication Trans-ankle lateral fusion is applicable to: 1. Traumatic ankle comminuted fractures, articular surface destruction, defects, old fractures and dislocations, joints can not be reconstructed. 2. Joint tuberculosis bone and joint destruction. 3. Septic arthritis, joint stiffness in non-functional position. 4. Horseshoe foot deformity, bone development has been deformed in adulthood, soft tissue surgery can not be corrected. 5. The calf muscle ischemic contracture, joint stiffness and plantar flexion deformity. 6. Polio sequelae, soft tissue surgery can not correct foot deformity. Contraindications 1. Children under 14 years of age who are not mature. 2. Lower limbs sensory disturbance and neurotrophic abnormalities. 3. Severe foot varus deformity. Surgical procedure 1. The posterior margin of the humerus (1) Incision: 8 cm from the lower part of the humerus, curved around the posterior border of the humerus to extend to the anterior border of the humerus. Cut the skin, subcutaneous tissue and deep fascia. (2) Cutting the humerus downwards: retracting the iliac crest, cutting the periosteum, peeling the humerus to the lateral iliac crest under the periosteum, leaving the iliac crest and the iliac ligament without dissection, cutting the humerus at the proximal end of the incision, and flipping the joint to the distal end. (3) Excision of articular cartilage surface: The periosteum of the tibia was cut longitudinally at the interosseous membrane, and the lateral surface of the tibia was removed under the periosteum. The anterior extensor tendon and blood vessels are retracted, the synovial membrane or tuberculosis tissue is removed, and the posterior synovium is removed, the foot is turned inward, the ankle joint is revealed, the intra-articular lesion is removed, and the wound is washed. The articular cartilage surface of the tibia and talus was removed (the lateral part of the talus was excised and retained for bone grafting), and the lateral cortex of the humerus was chiseled into a rough surface, and a bone groove was cut in the side of the humerus to embed the tibia in the groove. (4) Fixing the humerus: Hold the humerus with the bone holder, pressurize the tibia from the iliac crest and the sole of the foot, and reach the close contact between the iliac crest and the cancellous bone surface of the iliac crest. Select 3 screws to fix the humerus to the humerus. And the talus. (5) suture the incision: rinse the wound, relax the tourniquet, and completely stop the bleeding. The cut talus is bitten into pieces, filled in the gap, the wound is layered and sutured, and the long leg plaster tube is externally fixed. 2. Fusion of the anterior humerus approach (1) Incision: A straight incision is made from the lower end of the humerus along the anterior border of the humerus, about 12 cm long, and the distal end extends below the outer iliac crest. (2) Excision of the tibia to expose the joint: the skin and subcutaneous tissue are cut to reveal the tibia. The periosteum was dissected and the tibia was freed from the anterior to posterior periosteum. The anterior and posterior periosteum of the humerus was dissected, and the lateral surface of the humerus was dissected. The tibia adjacent cortex was cut vertically with a chainsaw or a bone knife, including the inferior tibiofemoral joint, the lateral ankle joint surface and the lateral part of the talus. The humerus was transected 6 cm above the iliac crest. Remove the distal radius of the humerus, expose the lateral side of the ankle joint, peel off the joint capsule to both sides, and place a wide-head stripper behind the sputum. (3) Bone graft fusion: Under the protection of the stripper, the humerus and talus articular cartilage surface were removed by a bone knife in parallel. For the end of the bone, the tibia which has been cut into a rough surface is placed close to the rough surface of the talus of the tibia, and they are in close contact with each other, and two screws are fixed on the proximal side of the joint, and one distal side is fixed. The outer part of the talus is cut and bitten into pieces between the interpupillary distances. (4) suture fixation: relax the tourniquet, completely stop bleeding, layered suture incision, knee extension 30 ° long leg cast fixed.

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