任甜甜医生的科普号

孩子脚内八，脚后跟内翻怎么回事？ 很多家长以为孩子还小，慢慢长大会自己恢复，殊不知这可能是一种足部畸形：高弓内翻足。这是是一种指足弓异常增高、负重时足弓无法放平的足部畸形。病因包括先天性马蹄内翻足、创伤性畸形、神经系统疾病如脊髓栓系综合征等。典型的畸形表现为高弓、马蹄、爪形趾畸形，后足内翻。足纵弓较高，足长度变短，跖趾关节背伸，趾间关节跖屈。跟腱挛缩，跖腱膜挛缩，足背伸无力。 轻度高弓内翻足患儿可通过穿戴特殊支具进行治疗，进展性的中重度患者则组要进行手术治疗。 1、跟骨内翻畸形2、高弓畸形3、术前可见患者力线不正，下肢内翻4、术前可见患者高弓畸形，第一跖骨压低。5、肌腱转位术6、截骨矫形术7、术后即刻，患者下肢力线恢复正常

跟腱，全身最粗壮的肌腱。跟腱断裂，多见于30-40岁的男性，多伴有运动外伤史。跟骨结节上2-6cm最窄、血供最差，是最容易发生断裂的部位传统的手术为切开直接缝合，并发症多：切口感染、皮肤坏死、腓肠神经损伤等我们现在采用微创的关节镜方法进行修复1、采用Bunnel缝合法远近的分别进行两次交叉跟腱两侧分别取5个切口中间切口为关节镜操作入口2、术中见断端瘀血及迂曲的跟腱断端，予以清理3、关节镜下直接穿针缝合4经皮打结该微创方法，创伤小，恢复快，是目前国际主流的跟腱微创修复方法。

Ankle Sprain踝关节扭伤A Patient’s Guide to Ankle Sprain踝关节扭伤患者指南Treatment治疗What can be done for the problem?如何治疗踝关节扭伤？Nonsurgical Treatment非手术治疗Nonsurgical treatment options depend on whether your problem is an ankle sprain or ankle instability. 非手术治疗的选择取决于你遭受是踝关节扭伤还是踝关节不稳。Ankle Sprain踝关节扭伤The best results after an ankle sprain come when treatment is started right away. Treatments are used to stop the swelling, ease pain, and protect how much weight is placed on the injured ankle. A simple way to remember these treatments is by the letters in the wordRICE.These stand for rest, ice, compression, and elevation. 在扭伤发生后立即开始治疗，这有助于取得最好的结果。治疗方法包括：减轻肿胀、缓解疼痛、控制患足的负重。有一个简单的记住这些治疗手段的方法，即单词“大米”（RICE），它代表着踝关节扭伤的治疗方法：休息（rest）、冰敷（ice）、加压包扎（comprssion）、抬高患肢（elevation）Rest: The injured tissues in the ankle need time to heal. Crutches will prevent too much weight from being placed on the ankle.Ice: Applying ice can help ease pain and may reduce swelling.Compression: Gentle compression pushes extra swelling away from the ankle. This is usually accomplished by using an elastic wrap.Elevation: Supporting your ankle above the level of your heart helps control swelling.休息：损伤的组织需要时间恢复，使用拐杖有助于减少患足的负担。冰敷：冰敷有助于缓解疼痛、减轻肿胀。加压包扎：适当的加压包扎可以减轻踝关节的肿胀，通常是使用弹力绷带进行加压包扎抬高患肢：将患肢抬高超过心脏水平，可以控制肿胀。Your doctor may also prescribe medications. Mild pain relievers help with the discomfort. Anti-inflammatory medications can help ease pain and swelling and get people back to activity sooner after an ankle sprain. These medications include common over-the-counter drugs such as ibuprofen. But newer anti-inflammatory medicines calledCOX-2 inhibitorsshow promising results and don’t seem to cause as much stomach upset and other intestinal problems. 你的医生也会给你开一些药物。一些止痛药可以缓解不适。消炎镇痛药物可以缓解疼痛减轻肿胀，可以让患者尽快的返回的到日常活动中去。这些药物包括常见的非处方药如布洛芬（芬必得）。还有一类新型的消炎镇痛药，属于COX-2抑制剂，具有更好的疗效，且不会引起胃部不适及一些其他的消化道问题。As treatment progresses, it is helpful to gradually begin putting weight through the joint. Casts have fallen out of favor because soft tissues weaken when they are kept immobile. But braces that can be worn to support the ankle, but still allow weight bearing, are the most popular treatment for helping reduce strain on the healing tissues. 随着治疗的进行，患足逐步负重是有利于恢复的。石膏固定会减弱软组织的力量，所以一般不建议使用。佩戴踝关节支具既可以保护踝关节又可以允许患足负重，是帮助减少恢复中的组织扭伤的流行治疗方法。Healing of the ligaments usually takes about six weeks, but swelling may be present for several months. Your doctor may suggest that you work with a physical therapist to help you regain full range of ankle motion, improve balance, and maximize strength. 韧带损伤的恢复通常需要六周时间，但肿胀可能会持续数月之久。你的医生会建议你与理疗师多接触，以帮助你重获踝关节的活动度、提高踝关节的平衡性及恢复踝关节的肌力。Ankle Instability踝关节不稳定If the ankle ligaments do not heal adequately, you may end up with ankle instability. This can cause the ankle to give way and feel untrustworthy on uneven terrain. If your ankle ligaments do not heal adequately following an ankle sprain, your doctor may suggest several things. 如果踝关节扭伤没有得到充分的恢复，将会导致踝关节不稳。这会造成患者在凹凸不平的路面行走时，会感觉踝关节崩溃不值得信融赖。如果在踝关节扭伤后，踝关节韧带并未充分愈合，你的医生会给你以下几个建议：Changes in your footwear may be prescribed to help keep your ankle from turning in. Placing a heel wedge under the outer half of your heel blocks the ankle from rolling, as does a flared heel built into your shoe. In extreme cases, doctors may prescribe a plastic brace, called anorthosis, to firmly hold your ankle from rocking side to side. Some patients feel a sense of steadiness from wearing high-topped shoes. Patients with ankle instability should avoid wearing high-heeled shoes. 首先是改变你的鞋，以防止你的踝关节总是处于内翻状态。在你足跟底部外侧半放置足跟垫，可以阻止踝关节的内翻，或穿一双足跟外展的鞋也可以起到同样的效果。对一些严重踝关节不稳的患者，医生可能会推荐使用塑料支具，即所谓矫正器，它可以牢牢的固定踝关节，防止踝关节晃动。一些患者可以穿高帮鞋，这有助于提高踝关节的稳定性。踝关节不稳患者应该避免穿高跟鞋。Physical therapy treatments will likely be initiated to help restore joint range of motion, strength, and joint stability. 理疗有助于恢复踝关节活动度，增强踝关节肌力及提高踝关节稳定性。Small nerve sensors inside the ligament are injured when a ligament is stretched or torn. These nerve sensors give your brain information about the position of your joints, a sensation calledposition sense. For example, nerve sensors in your arm andhandgive you the ability to touch your nose when your eyes are closed. The ligaments in the ankle work the same way. They send information to your nervous system to alert you about the position of your ankle joint. A physical therapist will help you retrain this sensation as a way to steady the ankle joint and protect you from spraining your ankle again. 当踝关节韧带拉伤或撕裂时，其内的一些小的神经感受器也会发生损伤。这些感受器用来帮助大脑确定关节的位置，这叫本体感觉。比如，你胳膊和手里的位置感受器能让你在闭眼的时候也能很准确的摸到自己的鼻子。踝关节韧带里的位置感受器也起着同样的作用，它们会告诉大脑踝关节的位置。理疗师会帮助你重建本体感觉以稳定踝关节并防止踝关节再次扭伤。Many people who have ankle instability have weakness in the muscles along the outside of the leg and ankle. These are called theperoneal muscles. Strengthening these muscles may help control the ankle joint and improve joint stability. 很多踝关节不稳的患者，其小腿及踝关节腓侧肌肉的肌力会下降，这些肌肉一般指的是腓骨长短肌。加强这些肌肉的肌力有助于增强患者对踝关节的控制并提高踝关节的稳定性。Surgery手术治疗Surgeons will occasionally do procedures right away in athletes who tear a lateral ankle ligament. In most other cases of torn ankle ligaments, surgeons will try nonsurgical treatments before doing reconstructive surgery of the ligaments. 对于一些踝关节外侧韧带撕裂的运动员，外科医生会选择立即进行手术治疗，但对于其他普通人来说，在进行外科手术治疗之前，通常建议首先尝试非手术疗法。Ligament Tightening Procedure韧带紧缩术Chronic ankle instability can happen when the lateral ankle ligaments are stretched or torn and the ankle keeps giving way. Surgery can be done to tighten the stretched ligaments and improve the stability of the ankle. The surgery usually involves the ATFL and theCFL. 当踝关节外侧韧带拉伤或撕裂时，会导致慢性踝关节不稳。可以将拉伤的韧带进行紧缩以提高踝关节的稳定性。手术通常是紧缩距腓前韧带和跟腓韧带。In this procedure, an incision is made in the skin that lies over the lateral ligaments. Using a scalpel, the surgeon cuts the ATFL and CFL in half. 沿着踝关节外侧韧带表面取切口，切开后皮肤后，显露距腓前韧带和跟腓韧带，使用刀片自其中部切断。Holes are drilled along the lower end of the fibula bone, the small bone of the lower leg. The two ends of the cut ligament are overlapped and sewn together. The surgeon uses the drill holes in the fibula to hold the stitches to the bone. 在腓骨（小腿的小骨头）远端钻孔，将切断的韧带两个断端重叠并缝合，通过腓骨远端的孔将韧带固定于腓骨。A large band of connective tissue crosses the front of the ankle just below the lateral ligaments. This band, called theankle retinaculum, holds the tendons in place. The surgeon pulls the top edge of the ankle retinaculum upward and sews it into the fibula.This helps reinforce the reconstructed ligaments. 踝关节下支持带，位于踝关节前方，恰好走形于踝关节外侧韧带的下方。通常，外科医生会将踝关节下支持带的上半部分缝合于腓骨远端，以加强重建韧带的力量。The following images show each step of the ligament tightening procedure:下图将描述韧带紧缩术的过程： 第一步：自韧带中部切断 第二步；腓骨远端钻孔 第三步：韧带缝合于腓骨 第四步：缝合踝关节下支持带。Step 1Step 2Step 3Step 4Tendon GraftProcedure肌腱移植术Another type of reconstruction is done using a tendon graft. If your surgeon feels that the stretched and scarred ligaments are not strong enough to simply repair in a ligament tightening procedure, then the ligaments must be reinforced with a tendon graft. 另一种韧带重建术需要肌腱移植。如果外科医生认为将仅仅对拉伤或疤痕化的韧带进行紧缩重建，依然不够牢固，这时就需要移植肌腱来强化韧带。In this procedure, the surgeon removes a portion of one of the nearby tendons to use as a tendon graft. The tendon most commonly used attaches theperoneus brevismuscle to the outside edge of the small toe. A section of this tendon is put in place of the torn lateral ligaments. 在这一手术过程中，术者会切取踝关节外侧临近肌腱的一部分进行移植。通常，会切取腓骨短肌腱的一部分，然后将其缝合于撕裂的外侧韧带。After making the skin incision, the surgeon drills a hole in the fibula near the attachment of the original ligament. A second drill hole is made in the area where the ligament attaches on the talus (the anklebone). 完成皮肤切口后，术者在踝关节外侧韧带于腓骨远端及距骨的止点附近钻孔。The tendon graft is then removed (orharvested) and woven between these holes to recreate the ligament complex. 然后切取腓骨短肌腱，穿过腓骨与距骨的钻孔，以重建外侧韧带复合体。After surgery, you will probably be placed in acastor brace for about six weeks to allow the tendon reconstruction to heal. Following removal of the cast, physical therapy will be required to regain full use of the ankle. 术后，踝关节需要使用石膏或支具固定六周，以使重建的韧带愈合。拆除石膏后，马上开始理疗，以获得踝关节功能完整的恢复。Rehabilitation康复What will it take to make my ankle healthy again?如何使踝关节重获健康。Nonsurgical Rehabilitation非手术治疗后的康复Even if you don’t need surgery, you may need to follow a program of rehabilitation and exercise. Doctors recommend that their patients work with a physical therapist for two to four weeks. Your therapist can create a program to help you regain ankle function. It is very important to improve strength and coordination in the ankle. 即使你没有接受手术治疗，你也需要接受一系列的康复锻炼计划。医生会推荐你在康复师的指导下进行康复锻炼，这一般需要两到四周的时间。理疗师会帮你制定康复计划，以恢复恢复踝关节的功能。其中，最重要的是恢复踝关节的力量及协调性。Swelling and pain are treated with ice andelectrical stimulation. If swelling in the ankle is severe, therapists may also apply massage strokes from the ankle toward thekneewith your leg kept in an elevated position. This helps get the swelling moving out of the ankle and back into circulation. Your therapist may issue a compression wrap and instruct you to wrap your ankle and lower limb and to elevate your leg. 肿胀和疼痛可以通过冰敷和电刺激疗法进行治疗。如果肿胀很严重，理疗师可能还会采用按摩疗法，将你的患肢抬高，然后自踝关节向膝关节进行按摩。这有助于踝关节的消肿，并促使渗液返回入循环系统。理疗师会对你进行加压包扎，并指导你如何包扎你的踝关节和小腿。Therapists also apply specialized hands-on treatment calledjoint mobilizationto improve normal joint motion. These treatments restore the gliding motion within the ankle joint where the lower leg meets the talus bone. This form of treatment speeds healing after an ankle sprain, and it helps return people and players more quickly to their activity or sport. 理疗师还会采用特殊手动疗法，即所谓的关节活动疗法，用来提高踝关节的活动度。这些疗法可以提高胫距关节面的滑动度，加快踝关节扭伤后的康复速度，并使得普通患者和运动员更快的返回日常生活和运动中去。An effective treatment for ankle sprains isdisc training, which uses a circular platform with a small sphere under it. Patients place their feet on it while they sit or stand and work the ankle by tilting the disc in various positions. This form of exercise strengthens the muscles around the ankle, and it improves joint sense (mentioned earlier). 还有一种踝关节扭伤的锻炼方式，称为圆盘训练。使用一个底部有一个小球的圆盘，患者可取站立位或坐位，将脚放置于圆盘之上，然后往不同方向旋转圆盘。这种形式的锻炼可以加强踝关节周围肌肉的肌力，并提高踝关节的本体感觉。When you get full ankle movement, your ankle isn’t swelling, and your strength is improving, you’ll be able to gradually get back to your work and sport activities. An ankle brace may be issued for athletes who intend to return quickly to their sport. 当你的踝关节活动度得到完全的恢复，没有肿胀且肌力足够时，你就能逐步返回你的日常工作和运动中去。对于那些想尽快回到运动中去的运动员来说，最好穿戴踝关节支具。After Surgery手术后的康复Patients usually take part in formal physical therapy after surgery. Rehabilitation after surgery can be a slow process. You will probably need to attend therapy sessions for two to three months, and you should expect full recovery to take up to six months. 接受手术治疗的患者术后通常会进行正式的理疗，术后的康复锻炼通常是一个缓慢的过程。你可能需要进行两到三个月的康复锻炼，而踝关节功能得到完全的恢复则需要半年时间。Rehabilitation proceeds cautiously after reconstruction of the ankle ligaments. Most patients are prescribed an ankle brace to wear when they are up and about, and they are strongly advised to follow the recommendations about how much weight can be borne while standing or walking. You may be instructed to put little or no weight on your foot when standing or walking for up to 12 weeks. Your physical therapist will work with you to make sure you are using crutches safely and only bearing the recommended amount of weight on your foot. 踝关节韧带重建后的康复锻炼需要小心谨慎的进行。绝大多数的患者都需要穿戴踝关节支具，并且在站立或行走时，严格控制患足的负重量。术后12周内，确保你的患足不负重或轻微负重。你的理疗师会一直与你保持联系，以确保你能安全的使用拐杖，且患足承受适当负重量。The first few physical therapy treatments are designed to help control pain and swelling from the surgery. Ice and electrical stimulation treatments may be used during your first few therapy sessions to help control pain and swelling. Your therapist may also use massage and other hands-on treatments to ease muscle spasm and pain. 首先开始的理疗主要是用于控制术后的疼痛和肿胀，这期间会采用冰敷和电刺激治疗。你的理疗师也会采用按摩或其他手法治疗来缓解肌肉痉挛和疼痛。Treatments are also used to help improve ankle range of motion without putting too much strain on the healing ligaments. 一些其他的治疗方法也会使用，用于提高踝关节活动度，并且不会在重建韧带上施加太多的外力。After about six weeks you may start doing more active exercise. Exercises are used to improve the strength in the peroneal muscles. Your therapist will also help you retrain position sense in the ankle joint to improve the stability of the joint. 一般六周后，你就可以开始进行适当的主动锻炼了，这些锻炼有助于提高腓侧肌肉的肌力。你的理疗师也会帮助你重建本体感觉以提高踝关节的稳定性。The physical therapist’s goal is to help you keep your pain under control, improve range of motion, and maximize strength and control in your ankle. When you are well under way, regular visits to the therapist’s office will end. Your therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program. 理疗师的作用就是帮你控制疼痛、提高踝关节活动度及增加肌力。如果康复锻炼计划完成，你就不需要定期去理疗师门诊随访了。但作为家庭康复计划的一部分，你仍然需要坚持锻炼。

Ankle Sprain踝关节扭伤A Patient’s Guide to Ankle Sprain踝关节扭伤患者指南Introduction简介Anankle sprainis a common injury and usually results when the ankle is twisted, or turned in (inverted). The termsprainsignifies injury to the soft tissues, usually the ligaments, of the ankle. 踝关节扭伤是生活中很常见的损伤，通常是由于踝关节内翻损伤所导致。术语“扭伤”一般指的是软组织的损伤，在踝关节，通常指的是韧带损伤。This guide will help you understandhow an ankle sprain occurshow doctors diagnose the conditionwhat can be done to treat a sprain本指南旨在帮助你了解踝关节扭伤是怎样发生的如何诊断踝关节扭伤如何治疗踝关节扭伤Anatomy解剖What part of the ankle is involved?踝关节包括哪些结构？Ligamentsare tough bands of tissue that help connect bones together. Three ligaments make up thelateral ligament complexon the side of the ankle farthest from the other ankle. They are theanterior talofibular ligament(ATFL),thecalcaneofibular ligament(CFL), and theposterior talofibular ligament(PTFL).The common inversion injury to the ankle usually involves two ligaments, the ATFL and CFL. Normally, the ATFL keeps the ankle from sliding forward, and the CFL keeps the ankle from rolling inward on its side. 韧带是一种致密的带状组织，它把相邻骨关节连接在一起。踝关节外侧韧带复合体由三条韧带组成：距腓前韧带、跟腓韧带、距腓后韧带。踝关节内翻扭伤通常累及其中两条韧带：距腓前韧带和跟腓韧带。距腓前韧带防止踝关节前移，跟腓韧带防止踝关节过度内收。Related Document:A Patient’s Guide to Ankle Anatomy相关阅读：英汉对照骨科患者指南001：踝关节解剖警告：请在有WIFI的场所观看视频，土豪请随意。本视频由张正阳翻译，更多解剖视频，请关注微信公众平台《张正阳Thomas》Causes病因Why do I have this problem?为什么我的踝关节会扭伤？A ligament is made up of multiple strands of connective tissue, similar to a nylon rope. A sprain results in stretching or tearing of the ligaments. Minor sprains only stretch the ligament. A tear may be either a complete tear of all the strands of the ligament or a partial tear of only some of the strands. The ligament is weakened by the injury; how much it is weakened depends on the degree of the sprain. 韧带是由多股束带状结缔组织组成，很像是一股尼龙绳。扭伤会导致韧带的拉伤或撕裂。轻微扭伤仅仅导致韧带的拉伤。严重扭伤会导致韧带撕裂，而韧带撕裂既可能是韧带内全部束带的断裂，也可能是部分束带的断裂。韧带损伤后，其力量会减弱，具体减弱的程度取决于扭伤的程度。The lateral ligaments are by far the most commonly injured ligaments in a typicalinversion injuryof the ankle. In an inversion injury the ankle tilts inward, meaning the bottom of thefootangles toward the other foot. This forces all the pressure of your body weight onto the outside edge of the ankle. As a result, the ligaments on the outside of the ankle are stretched and possibly torn. 踝关节外侧韧带损伤最常见于踝关节内翻损伤。何谓踝关节内翻损伤？就是发生扭伤时，扭伤的这只脚的足底朝向另外一只脚，这样全身的重量都集中于踝关节的外侧，结果导致了踝关节外侧韧带的拉伤或撕裂。A severe form of ankle sprain, called anankle syndesmosis injury, involves damage to other supportive ligaments in the ankle. This type of injury is sometimes called ahigh ankle sprainbecause it involves the ligaments above theankle joint. In an ankle syndesmosis injury, at least one of the ligaments connecting thetibiaandfibulabones (the lower leg bones) is sprained. Recovering from even mild injuries of this type takes at least twice as long as from a typical ankle sprain. 有一种严重的踝关节扭伤，又称踝关节下胫腓联合损伤，累及踝关节的其他支持韧带。这种类型的踝关节扭伤又称高位踝关节扭伤，因为它累及的韧带位于踝关节上方。踝关节下胫腓联合损伤发生时，至少有一条连接胫腓骨远端的韧带发生拉伤或撕裂，即使是轻微的下胫腓联合损伤，其恢复时间至少是普通踝关节扭伤的两倍。Related Document:A Patient’s Guide to Ankle Syndesmosis Injuries相关阅读：踝关节下胫腓联合损伤患者指南（待翻译，有兴趣者请留言）Symptoms症状What does an ankle sprain feel like?踝关节扭伤后有哪些表现？Initially the ankle is swollen, painful, and may turnecchymotic(bruised). The bruising and swelling are due to ruptured blood vessels from the tearing of the soft tissues. Most of the initial swelling is actually bleeding into the surrounding tissues. The ankle swells as extra fluid continues to leak into the tissues over the 24 hours following the sprain. 踝关节扭伤发生后，最初的症状是肿胀、疼痛、淤青，这是由于撕裂的软组织内血管发生破裂，进而血液渗出到踝关节周围所致。随着扭伤后24小时或更长时间，额外的液体不断渗漏入组织，踝关节发生肿胀。People who have sprained an ankle often end up spraining the ankle again. If the ankle keeps turning in with activity, the condition is calledankle instability. Patients who have ankle instability lose confidence in their ankle to support them, especially on uneven ground. They often have swelling around the ankle that doesn’t go away. Pain and swelling in a joint can cause a reflex where the body turns off the muscles around the joint. This can cause times when the ankle feels like it is going to give way, meaning it may have a tendency to twist again very easily. 一旦踝关节发生过一次扭伤，就很容易再次发生扭伤。如果踝关节反复多次扭伤，这被称之为“踝关节不稳”，这种情况会导致患者对他们的踝关节的功能失去信心，尤其是在凹凸不平的路面行走时。这类患者的踝关节总是反复肿胀而不能消退。关节的疼痛和肿胀会反射性地使人们不使用关节周围的肌肉。这会不时地让人们感觉踝关节似乎将要垮掉了，也说是说踝关节更容易再次扭伤。People who have had several mild ankle sprains or one severe sprain are prone to impingement problems in the ankle. The ligaments that were sprained may become irritated and thickened, causing them to get pinched near the edge of the ankle joint. 反复多次的轻度踝关节扭伤或一次严重的踝关节扭伤均可导致踝关节撞击综合征。扭伤韧带会发炎并增厚，导致在踝关节边缘附近出现撞击。Related Document:A Patient’s Guide to Ankle Impingement Problems相关阅读：踝关节撞击综合征患者指南（待翻译，有兴趣者请留言）Diagnosis诊断How do doctors diagnose the condition?医生是如何诊断踝关节扭伤的The diagnosis of an ankle sprain is usually made by examination of the ankle and X-rays to make sure that the ankle is not fractured. A physical examination is used to determine which ligament has been injured. The doctor will move your ankle in different positions in order to check the ligaments and other soft tissues around the ankle. Some tests place stress directly on the ankle ligaments to see if the ankle has become unstable and to find out if one or more ligaments has been partially or completely torn. 踝关节扭伤的诊断通常是通过体格检查，然后拍摄X片排除踝关节骨折。体格检查可以判断哪一根韧带发生损伤。你的医生会在不同方向活动你的踝关节，以检查踝关节韧带和周围软组织。一些特殊的体检试验，直接把应力施加于踝关节韧带，通过踝关节的稳定程度来判断是否有韧带损伤，一根或多跟韧带损伤，是部分还是全部撕裂。If a complete rupture of the ligaments is suspected, your doctor may orderstress X-raysas well. These X-rays are taken while the ligaments are placed in a stretched position. The X-ray will show a slight tilt in the ankle bone if the ligaments have been torn. 如果你的医生怀疑你的韧带全部撕裂，他会建议你去拍摄一个应力位的X片。所谓应力位X片即你拍片时，你的踝关节会被施加一个外力，以使得韧带处于张力状态。如果存在韧带撕裂，那么在X片上会表现出踝关节骨头的轻度倾斜。

Surgical Procedure手术过程What happens during ankle arthroscopy? 踝关节镜手术怎么进行？Before surgery you will be placed under either general anesthesia or a type of spinal anesthesia. The ankle joint is very tight with little space between the tibia and the talus. By applying traction, the surgeon is able to increase this space and allow the arthroscope to be inserted into that space. The end of the arthroscope will be moved about in this space to look throughout the joint. Finally, sterile drapes are placed to create a sterile environment for the surgeon to work. There is a great deal of equipment that surrounds the operating table including the TV screens, cameras, light sources and surgical instr 术前，你会接受全麻或腰麻。踝关节位于胫骨与距骨之间，这一间隙非常狭窄。通过对踝关节进行牵引，可以扩大这一间隙，以使得关节镜能插入踝关节，然后对踝关节进行全面的检查。麻醉和牵引完成后，进行无菌铺单以创造一个无菌的手术操作环境。在手术台周围还有大量的手术设备，包括：显示屏、摄像机、光源以及外科手术器械。The surgeon begins the operation by making two or three small openings into the ankle, calledportals. These portals are where the arthroscope and surgical instruments are placed inside the ankle. Care is taken to protect the nearby nerves and blood vessels. A small metal or plastic tube (orcannula) will be placed through one of the portals to inflate the ankle with sterile saline. 术者首先在踝关节取两到三个小切口，关节镜及手术器械通过这些切口进入踝关节。注意保护切口周围的神经及血管。一个小的金属或塑料套管会通过其中一个切口插入踝关节，然后注入无菌生理盐水。The arthroscope is a small fiber-optic tube that is used to see and operate inside the joint. The arthroscope is a small metal tube about 1/4 inch in diameter (slightly smaller than a pencil) and about 7 inches in length. The fiberoptics inside the metal tube of the arthroscope allows a bright light and TV camera to be connected to the outer end of the arthroscope. The light shines through the fiberoptic tube and into the ankle joint. A TV camera is attached to the lens on the outer end of the arthroscope. The TV camera projects the image from inside the ankle joint on a TV screen next to the surgeon. The surgeon actually watches the TV screen (not the ankle) while moving the arthroscope to different places inside the ankle joint. 关节镜的前端是一根细细的纤维光纤，其直径大约0.25英寸（略小于一根铅笔的直径），大约7英寸长。纤维光纤将光源与摄像头连接于关节镜的外侧端，然后光线就可通过光纤进入踝关节。摄像头亦亦连接于关节镜的外侧端，然后将踝关节内的影响发送到术者旁边的屏幕上。术者实际上是看着屏幕来操作关节镜，而不是看着踝关节。Over the years since the invention of the arthroscope, many very specialized instruments have been developed to perform different types of surgery using the arthroscope to see what is going on while the instruments are being used. Today, many surgical procedures that once required large incisions for the surgeon to see and fix the problem can be done with much smaller incisions. For example, simple removal of a loose body in the ankle can be done using two or three small 1/4 inch incisions. More extensive surgical procedures may require larger incisions. Your surgeon may decide during the procedure that the problem requires a more traditional open type operation. If this has been discussed before the operation the surgery may be performed immediately; if not, the arthroscopic procedure will be concluded and a later operation planned. Your surgeon will discuss the details of what was found at the time of the arthroscopy and what more needs to be done in the later operation. 自从关节镜被发明以来，许多专门的器械也被设计出以进行不同的手术操作。现在，很多需要在大切口下进行的手术操作，都可在小切口下完成。比如，清除关节游离体，就可在两或三个0.25英寸的小切口下完成。更广泛的手术可能需要大的切口，你的医生可能在术中做出决定，是否需要传统的开放式切口进行手术。如果术前你的医生予以进行沟通过，那么他会立即进行开放式手术。如果没有，关节镜手术将会结束，然后进入二期手术。你的医生将会跟你沟通术中发现了什么，二期手术还需要进行什么。Once the surgical procedure is complete, the arthroscopic portals and surgical incisions will be closed with sutures or surgical staples. You may be placed in a large compressive bandage and splint that will be applied from thekneeto the toes. The splint and bandage is used to immobilize and protect the ankle. If your surgeon feels that you do not need a bulky bandage and splint, you may be placed in compression stockings. A compressive bandage (or stockings) reduce swelling and help prevent blood clots in the leg. Once the bandage has been placed, you will be taken to the recovery room. 一旦手术完成，切口将被缝合。你的下肢会被用弹力绷带及夹板固定，固定范围从你的膝关节到脚趾，以保护你的踝关节。如果你的外科医生认为你不需要支具的保护，你可能需要弹力袜。弹力绷带或弹力袜可以减轻肿胀，并阻止血栓的形成。固定完成后，你就会被带到康复室。Complications并发症What can go wrong? 术后有后遗症吗？As with all major surgical procedures, complications can occur during ankle arthroscopy. This document doesn’t provide a complete list of the possible complications, but it does highlight some of the most common problems. Some of the most common complications following ankle arthroscopy are和其他手术操作一样，关节镜手术也有并发症。本文不会提供所有并发症的清单，但我们列出了一些最常见的并发症：·anesthesia complications·thrombophlebitis·infection·equipment failure·slow recovery 麻醉并发症血栓感染设备失效延迟恢复Anesthesia Complications麻醉并发症Most surgical procedures require that some type of anesthesia be done before surgery. A very small number of patients have problems with anesthesia. These problems can be reactions to the drugs used, problems related to other medical complications, and problems due to the anesthesia. Be sure to discuss the risks and your concerns with your anesthesiologist. 绝大多数手术在术前都需要进行麻醉，非常少的患者会有麻醉并发症。这些并发症可能是对麻醉药的不良反应，或麻醉本身导致的问题。术前与麻醉师就你所担心及麻醉风险进行充分的沟通。Thrombophlebitis (Blood Clots)血栓Thrombophlebitis, sometimes called deep venous thrombosis (DVT), can occur after any operation, but is more likely to occur following surgery on thehip, pelvis, or knee. DVT occurs when blood clots form in the large veins of the leg. This may cause the leg to swell and become warm to the touch and painful. If the blood clots in the veins break apart, they can travel to the lung, where they lodge in the capillaries and cut off the blood supply to a portion of the lung. This is called apulmonary embolism. (Pulmonary means lung, and embolism refers to a fragment of something traveling through the vascular system.) Most surgeons take preventing DVT very seriously. There are many ways to reduce the risk of DVT, but probably the most effective is getting you moving as soon as possible after surgery. Two other commonly used preventative measures include 血栓，又称深静脉血栓，可发生于任何手术。但最常发生于髋、骨盆及膝关节的手术。深静脉血栓常发生于下肢大的静脉内形成血栓，这将导致下肢肿胀、疼痛及皮温增高。如果静脉内地血栓破碎脱落，将会游走至肺部，并堵塞肺部的毛细血管，从而阻断了肺的部分血供，这就是所谓的肺栓塞。大多数外科医生，都会很慎重的预防深静脉血栓。有许多种方法会减少深静脉血栓的形成，其中最有效的方法就是术后尽可能早的恢复活动。两种其他的常用的预防方法是：·pressure stockings to keep the blood in the legs moving·medications that thin the blood and prevent blood clots from forming 弹力袜，以使得血流保持通畅稀释血液的药物，以减少血栓的形成Infection感染Following ankle arthroscopy, it is possible that a postoperative infection may occur. This is very uncommon and happens in less than 1% of cases. You may experience increased pain, swelling, fever and redness or drainage from the incisions. You should alert your surgeon if you think you are developing an infection. 关节镜术后，存在发生感染的可能，大约不到1%的患者会发生感染。你可能会经历逐渐增加的疼痛、肿胀、发热、红肿或切口的渗出。你需要提醒你的医生，如果你感觉你发生了感染。Infections are of two types: superficial or deep. A superficial infection may occur in the skin around the incisions or portals. A superficial infection does not extend into the joint and can usually be treated with antibiotics alone. If the ankle joint itself becomes infected, this is a serious complication and will require antibiotics and possibly another surgical procedure to drain the infection. 一般感染分两种类型：浅表型和深部型。浅表型感染多发生于切口周围，一般不会扩散到关节内，单纯使用抗生素就可以治愈。如果踝关节内部发生感染，这是很严重的并发症，不仅需要抗生素的治疗，还需要再次手术以引流感染。Equipment Failure设备破损Many of the instruments used by the surgeon to perform ankle arthroscopy are small and fragile. These instruments can be broken resulting in a piece of the instrument floating inside of the joint. The broken piece is usually easily located and removed, but this may cause the operation to last longer than planned. There is usually no damage to the joint due to the breakage. 术者使用的关节镜器械很多都是精巧易碎的，手术过程中，这些器械一旦发生破损，就会有部分碎屑漂浮在关节内。这些碎屑一般来说是比较容易定位和清除的，但这会增加手术时间。通常这些碎屑是不会对关节造成损害的。Different types of surgical devices (screws, pins and suture anchors) are used to hold tissue in place during and after arthroscopy. These devices can cause problems. If one breaks, the free-floating piece may hurt other parts inside the joint, particularly thearticular cartilage. The end of the tissue anchor may poke too far through tissue and the point may rub and irritate nearby tissues. A second surgery may be needed to remove the device or fix problems with these devices. 不同类型的外科材料如：螺钉，克氏针，锚钉被用于在术中或术后固定组织，这些材料有可能引起并发症。一旦这些材料破损，其碎屑有可能对关节内部结构造成损害，尤其是关节软骨。锚钉的尾端有可能刺破组织，摩擦并激惹周围的组织，很可能需要二期手术去除锚钉。Slow Recovery延迟恢复Not everyone gets quickly back to routine activities after ankle arthroscopy. Because the arthroscope allows surgeons to use smaller incisions than in the past, many patients mistakenly believe thatless surgery was necessary. This is not always true. The arthroscope allows surgeons to do a great deal of reconstructive surgeryinsidethe ankle joint without making large incisions. How fast you recover from ankle arthroscopy depends on what type of surgery was doneinsideyour ankle. Simple problems that require simple procedures using the arthroscope generally get better faster. Patients with extensive damage to the articular cartilage in the ankle joint tend to require more complex and extensive surgical procedures. These more extensive reconstructions take longer to heal and have a slower recovery. You should discuss this with your surgeon and make sure that you have realistic expectations of what to expect following arthroscopic ankle surgery. 并不是所有人都能在踝关节镜术后很快的回到日常活动中。很多患者认为关节镜采用小的切口，所以手术创伤也会很小，这种看法是不对的。关节镜技术可是让术者在小切口下进行很懂关节内的重建手术。术后恢复的速度取决于医生对你的踝关节进行了什么手术。简单的问题简单的手术就可以解决，术后会恢复的很快。关节软骨广泛损伤的患者，需要复杂和深入的手术，这类患者需要更长时间恢复。你应该与你的医生进行详细的沟通，确保你有比较现实的期望对踝关节术后的恢复。After Surgery术后What happens after ankle arthroscopy?踝关节术后会发生什么？Ankle arthroscopy is usually done on an outpatient basis meaning that patients go home the same day as the surgery. More complex reconstructions that require larger incisions and surgery that alters bone may require a short stay in the hospital to control pain more aggressively and monitor the situation carefully. You may also begin physical therapy while in the hospital. 踝关节镜通常在门诊进行手术，这意味着患者可在术后当天就回家。一些比较复杂需要大切口的重建手术，以及涉及到骨头的手术可能需要住院几天以控制疼痛及密切监控生命体征，在住院期间即开始理疗。The portals are covered with surgical strips, the larger incisions may have been repaired with either surgical staples or sutures. Crutches are commonly used after ankle arthroscopy. They may only be needed for one to two days after a simple procedures. 关节镜小切口可以用外科绷带包扎，大的切口需要外科缝线或皮钉修复。术后通常使用拐杖，简单手术使用一到两天即可。Follow your surgeon’s instructions about how much weight to place on your foot while standing or walking. Avoid doing too much, too quickly. You may be instructed to use a cold pack on the ankle and to keep your leg elevated and supported. 术后当你站立或行走时，听取你医生的建议，患肢部分负重，不要做得太多，也不要做的太快。建议你用冰袋冷敷踝关节，并抬高患肢。Rehabilitation康复What will my recovery be like? 我康复锻炼是怎么进行的？Your rehabilitation will depend on the type of surgery required. You may not need formal physical therapy after simple procedures such as a simple debridement. Some patients may simply do exercises as part of a home program after some simple instructions. 你的康复方案取决你的接受了什么手术。如果你接受了简单的手术，如简单的清创，你可能不需要正式的理疗。有些患者仅仅需要简单家庭锻炼就可以了在接受了简单建议后。Many surgeons have patients take part in formal physical therapy after any type of ankle arthroscopy procedure. Generally speaking, the more complex the surgery the more involved and prolonged your rehabilitation program will be. The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. Physical therapists will also work with patients to make sure they are putting only a safe amount of weight on the affected leg. 很多外科医生都建议患者术后加入正式的理疗。一般来说，你接受的手术越复杂，你的康复计划就会越长。最初的理疗主要是帮助止痛和消肿。理疗师也会帮助患者安全的让患肢负重。Today, the arthroscope is used to perform quite complicated major reconstructive surgery using very small incisions. Remember, just because you have small incisions on the outside, there may be a great deal of healing tissue on the inside of the ankle joint. If you have had major reconstructive surgery, you should expect full recovery to take several months. The physical therapist’s goal is to help you keep your pain under control and improve the range of motion and strength of your ankle. When you are well under way, regular visits to your therapist’s office will end. The therapist will continue to be a resource, but you will be in charge of doing your exercises as part of an ongoing home program.现在，关节镜已经能在小切口下进行非常复杂的重建手术。记住，就是因为你有了小的切口在关节外，但在关节内却又大量的组织需要康复。如果你接受了大的重建手术，你可能需要几个月的恢复时间。理疗师的目的就是帮你控制疼痛，提高踝关节的活动度和肌力。当时顺利康复后，定期拜访理疗师就可以结束了。理疗师可以作为一个资源，但你自己需要负责自己锻炼，作为家庭计划的一部分。

Ankle Arthroscopy踝关节镜A Patient’s Guide to Ankle Arthroscopy踝关节镜病人指南Introduction介绍Arthroscopyis a procedure where a small video camera attached to a fiberoptic lens is inserted into the body to allow a physician or surgeon to see without making a large incision.Arthroscopyis now used to evaluate and treat orthopedic problems in many different joints of the body. Theankle jointis one of the common joints that arthroscopy is used to evaluate and treat problems with this minimally invasive technique. 关节镜技术，是一种将微型摄像头与一根光纤连接后，通过微创切口插入关节内，观察关节内部结构的技术。目前，关节镜技术被广泛的应用于全身多处关节，来诊断并治疗相关的关节疾病。其中踝关节镜技术，已被广泛用于临床进行踝关节疾病的诊断和治疗。This guide will help you understand·what parts of the ankle are treated during ankle arthroscopy·what types of conditions are treated with ankle arthroscopy·what to expect before and after ankle arthroscopy 这一指南有助于你了解：踝关节镜技术的诊疗范围踝关节镜技术的适应症踝关节镜技术围手术期注意事项Anatomy解剖What parts of the ankle are involved? 踝关节包括哪些结构？The ankle joint is formed by the connection of three bones. The top of thetalusfits inside a socket that is formed by the lower end of thetibia(shinbone) and thefibula(the small bone of the lower leg). The bottom of the talus sits on the heel bone, called thecalcaneus. 踝关节由三块相互连接的骨头组成。距骨，其上方位于由胫腓骨远端形成的踝穴内，基底部位于跟骨之上。Ligamentsare tough bands of tissue that connect bones together. Three ligaments make up thelateral ligament complexon the side of the ankle farthest from the other ankle. They are theanterior talofibular ligament(ATFL), thecalcaneofibular ligament(CFL), and theposterior talofibular ligament(PTFL). 踝关节周围包裹着一圈韧带，把骨性结构连接在一起。踝关节外侧韧带复合体由三根韧带组成：距腓前韧带(ATFL)，跟腓韧带(CFL)，距腓后韧带(PTFL)。The commonankle sprain, or inversion injury to the ankle, usually involves two ligaments, the ATFL and CFL. Normally, the ATFL keeps the ankle from sliding forward, and the CFL keeps the ankle from rolling inward on its side. On the side of the ankle joint closest to the otherfoot(themedialside) is another ligament called thedeltoidligament. 最常见的踝关节扭伤，或踝关节内翻损伤，通常会累及两根韧带：距腓前韧带和跟腓韧带。一般来说，距腓前韧带防止踝关节前移。跟腓韧带防止踝关节内旋。踝关节内侧也有一组韧带复合体，叫三角韧带。The deltoid ligament can be torn, but it is usually torn in a combination of injuries when the ankle is broken; it is uncommon to injure the deltoid ligament alone. 三角韧带也有可能撕裂，但通常是并发于踝关节损伤造成的多发韧带撕裂，单纯的三角韧带撕裂很少见。The ankle joint is surrounded by a water tight pocket called thejoint capsule. This capsule is formed by ligaments, connective tissue and synovial tissue. When the joint capsule is filled with sterile saline and is distended, the surgeon can insert the arthroscope into the pocket that is formed, turn on the lights and the camera and see inside the ankle joint as if looking into an aquarium. The surgeon can see the structures that are inside the ankle joint including the joint surfaces of the distal tibia, fibula and talus and the synovial lining of the joint. 踝关节被一个不透水的囊性结构所包裹，我们称之为踝关节囊。踝关节囊由韧带、结蹄组织、滑膜组成。给踝关节囊内充入无菌生理盐水，使其膨胀，然后术者就可插入踝关节镜，打开光源和镜头就可以直接观察踝关节内部结构：包括胫骨远端关节面，距骨及关节滑膜。Rationale基本原理What does my surgeon hope to accomplish? 我的医生能用踝关节镜进行什么操作?When ankle arthroscopy first became available it was used primarily to look inside the ankle joint and make a diagnosis. Today, ankle arthroscopy is used to perform a wide range of surgical procedures including confirming a diagnosis, removing loose bodies, removing bone spurs, debriding excess inflamed synovial tissue, and fixing fractures of the joint surface. 当关节镜技术首次被应用于踝关节时，它首先被用于观察踝关节内部结构及诊断疾病。现在，踝关节镜技术已经被广泛的应用于各种操作，比如：明确诊断，清除游离体，清除骨赘，清除过度增生的炎性滑膜组织以及固定关节面的骨折。Your surgeon’s goal is to fix or improve your problem by performing a suitable surgical procedure; the arthroscope is a tool that improves the surgeon’s ability to perform that procedure. The arthroscope image is magnified and allows the surgeon to see better and clearer. The arthroscope allows the surgeon to see and perform surgery using much smaller incisions. This results in less tissue damage to normal tissue and can shorten the healing process. But remember, the arthroscope is only a tool. The results that you can expect from a ankle arthroscopy depend on what is wrong with your ankle, what can be done inside your ankle to improve the problem and your effort at rehabilitation after the surgery. 你的医生的目的，就是选择合适的外科技术来治疗疾病。踝关节镜作为一种工具，能提高外科医生的手术水平。关节镜下图像是放大的，使得外科医生能看的更清楚。关节镜能使得外科医生在更小的切口下进行手术，给患者带来更小的软组织损伤，及更快的恢复过程。但是，请记住，关节镜仅仅是一个工具。踝关节镜手术的结果，取决于踝关节本身的疾病、踝关节内所进行的操作以及术后你在康复锻炼上所付出努力。Preparations术前准备What do I need to know before surgery? 术前我需要知道什么？You and your surgeon should make the decision to proceed with surgery together. You need to understand as much about the procedure as possible. If you have concerns or questions, be sure and talk to your surgeon. 你和你的手术医师，应该在术前共同制定手术方案。你应该尽可能多的了解手术过程。如何你有任何的疑问和担心，应咨询你外科医生。Once you decide on surgery, you need to take several steps. Your surgeon may suggest a complete physical examination by your regular doctor. This exam helps ensure that you are in the best possible condition to undergo the operation. 一旦你决定接受手术，你有几件事需要做。首先，你私人医生对你进行全面的体格检查，以确保你的身体处于最佳状态，以便接受手术。You may also need to spend time with the physical therapist who will be managing your rehabilitation after surgery. This allows you to get a head start on your recovery. One purpose of this preoperative visit is to record a baseline of information. The therapist will check your current pain levels, ability to do your activities and the movement and strength of each ankle. 其次，你需要与你的理疗师进行详细的沟通，他负责制定你的术后康复锻炼计划，这会使你的恢复有一个良好的开端。理疗师首先会了解你的基本资料，检查你目前的疼痛水平，运动能力以及每个踝关节的肌力水平。A second purpose of the preoperative visit is to prepare you for surgery. The therapist will teach you how to walk safely using crutches or a walker. And you’ll begin learning some of the exercises you’ll use during your recovery. 然后帮你进行术前准备，他会教你如何安全的使用拐杖或助行器进行行走。你也要开始学习一些在康复期间进行的锻炼方式。On the day of your surgery, you will probably be admitted for surgery early in the morning. You shouldn’t eat or drink anything after midnight the night before. 手术当天，你可能会在早上被送到手术室，术前一晚从午夜开始，你不能吃、喝任何东西。