骨科手术早知道003：经腓骨踝关节融合术（ANKLE FUSION, TRANSFIBULAR）

      关节融合术是一种促进关节骨性强硬的手术。当踝关节强直时，无疼痛及明显畸形，仍可步行和完成各种劳动，且手术对外观无甚影响，融合后丧失的功能可由跗中关节部分代偿，故术后效果多较满意，容易为病人接受。踝关节融合术是终止病变，解除疼痛，纠正畸形并提供关节稳定的有效手段，虽然其存在一定的弊端，如不愈合和畸形愈合会影响疗效，但是仍被视为严重受损踝关节的标准治疗方法。

      踝关节融合方法很多，显露途径也有不同，常用的有前侧显露与外侧显露。前侧入路显露较差，病灶清除不易彻底，仅用于融合。外侧入路切腓外踝，显露比较充分，病灶清除彻底，且较安全。

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Overview（概述）

This surgical procedure is performed to treat severe arthritis or injury of the ankle joint. During the  procedure, the surgeon removes damaged bone and cartilage and fuses the joint. This stabilizes the ankle and relieves pain.

      踝关节融合术用于治疗踝关节严重关节炎或损伤。术中，外科医生去除已被破坏的骨和软骨，并将关节融合。这样可以稳定踝关节，缓解疼痛。

Preparation（准备）

In preparation for the procedure, the patient is positioned and general anesthesia is administered. The surgeon creates an incision along the outer side of the ankle to expose the joint.

      准备手术时，将病人摆放合适体位并实施全身麻醉。外科医生在踝关节外侧作切口以显露关节。

Modifying the Fibula（修整腓骨）

The surgeon removes the end of the fibula (the long bone that rests against the tibia). In some cases the surgeon may also need to remove the bony bump that protrudes from the inner side of the ankle. If so, a second incision will be needed.

      外科医生将腓骨(倚靠着胫骨的长骨头）的远端去除。在有些病例，外科医生还需要去除踝关节内侧突出的骨赘，此时，需要作第二个切口。

Reshaping the Joint（关节重新塑形）

The surgeon removes damaged cartilage and bone from the end of the tibia and the talus. The surgeon reshapes these bones and adjusts their positions so that they are aligned properly. The surgeon may need to place bone grafts in gaps in the ankle to help achieve proper alignment. If grafts are needs, they may be taken from the section of fibula that was removed previously. Grafts may also be taken from the bone of the heel or the pelvis.  

      外科医生将受破坏的软骨和骨从胫骨和距骨末端去除，然后将这些骨头修成合适形状，调整它们的位置，使它们排列合适。外科医生可能需要在踝关节间隙内放置骨移植物以利于获得良好的对线。如果需要移植物，可以从先前去除的腓骨段获取。移植物也可以从跟骨或盆骨获取。

Stabilizing the Ankle（稳定踝关节）

Once the bones are aligned properly, the surgeon stabilizes the ankle with a series of screws, plates, or a combination of the two. This hardware joins the tibia and the talus. When the procedure is complete, the surgeon closes the incisions and places the foot in a cast. Over the next several weeks, the tibia and talus will fuse together permanently. The ankle will no longer flex and extend, but it will retain its side-to-side range of motion.

      一旦骨头排列合适，外科医生用一系列的螺钉、钢板或两者结合起来对踝关节进行固定。这些内固定材料将胫骨和距骨连接起来。当这些操作完成后，外科医生将切口关闭，并将脚置于石膏内。在接下来的几周时间里，胫骨和距骨会永久地融合在一起。踝关节将不能屈伸活动，但会保留侧向的活动。

After Care（术后护理）

After the surgery, most patients can go home after a short monitoring period. Crutches will be needed for six to eight weeks. Gradually, as the bones fuse, the patient will be able to bear weight on the leg.  Patients can typically resume normal activities within three to six months. Physical therapy will be needed.

术后，经过短期的监护，大多数患者可以回家。6～8周内需要使用拐杖。随着骨头逐渐融合，患者的腿可以承受一定的重量。通常在3～6月内患者可以恢复正常活动，在此期间可能需要物理治疗。

（胡佰文    译）