内踝截骨术的临床应用与进展

Clinical application and progress of medial malleolus osteotomy

距骨内侧骨折和距骨内侧骨软骨损伤由于内踝的遮挡往往难以暴露,内踝截骨术对于暴露上述病变有独特的优势,可以提高手术成功率,但国内对于该技术的应用仍较少。内踝截骨术的截骨方式有横行截骨、倒"U"型截骨、斜型截骨、阶梯式截骨、倒"V"型截骨等,尚未有研究指出何种截骨方式最优。截骨后内固定方式包括张力带固定、空心钉固定和新型接骨板固定等,各有特点,其中以空心钉固定最为常见,而近年来新型接骨板则表现出更好的生物力学特性。

It is very difficult to expose medial fractures and osteochondral lesions of the talus due to the cover of the medialmalleolus. The medial malleolus osteotomy has unique advantages in exposing these lesions, which can improve the successrate of surgery. But the application of the technology is still less in China. The ways of medial malleolus osteotomy includetransverse osteotomy, inverted "U" osteotomy, oblique osteotomy, step-cut osteotomy, chevron osteotomy, etc. No studiesindicate which method is optimal. The internal fixation methods after osteotomy include tension band fixation, lag screws andsled device and so on, and each has its own characteristic. Screws fixation is the most common, and sled fixation have shownbetter biomechanical properties in recent years.