關(guān)節(jié)融合術(shù)是一種促進(jìn)關(guān)節(jié)骨性強(qiáng)硬的手術(shù)。當(dāng)踝關(guān)節(jié)強(qiáng)直時(shí)，無(wú)疼痛及明顯畸形，仍可步行和完成各種勞動(dòng)，且手術(shù)對(duì)外觀無(wú)甚影響，融合后喪失的功能可由跗中關(guān)節(jié)部分代償，故術(shù)后效果多較滿意，容易為病人接受。踝關(guān)節(jié)融合術(shù)是終止病變，解除疼痛，糾正畸形并提供關(guān)節(jié)穩(wěn)定的有效手段，雖然其存在一定的弊端，如不愈合和畸形愈合會(huì)影響療效，但是仍被視為嚴(yán)重受損踝關(guān)節(jié)的標(biāo)準(zhǔn)治療方法。

      踝關(guān)節(jié)融合方法很多，顯露途徑也有不同，常用的有前側(cè)顯露與外側(cè)顯露。前側(cè)入路顯露較差，病灶清除不易徹底，僅用于融合。外側(cè)入路切腓外踝，顯露比較充分，病灶清除徹底，且較安全。

警告：請(qǐng)?jiān)谟蠾IFI的場(chǎng)所觀看視頻，土豪請(qǐng)隨意。

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.

      踝關(guān)節(jié)融合術(shù)用于治療踝關(guān)節(jié)嚴(yán)重關(guān)節(jié)炎或損傷。術(shù)中，外科醫(yī)生去除已被破壞的骨和軟骨，并將關(guān)節(jié)融合。這樣可以穩(wěn)定踝關(guān)節(jié)，緩解疼痛。

Preparation（準(zhǔn)備）

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.

      準(zhǔn)備手術(shù)時(shí)，將病人擺放合適體位并實(shí)施全身麻醉。外科醫(yī)生在踝關(guān)節(jié)外側(cè)作切口以顯露關(guān)節(jié)。

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.

      外科醫(yī)生將腓骨(倚靠著脛骨的長(zhǎng)骨頭）的遠(yuǎn)端去除。在有些病例，外科醫(yī)生還需要去除踝關(guān)節(jié)內(nèi)側(cè)突出的骨贅，此時(shí)，需要作第二個(gè)切口。

Reshaping the Joint（關(guān)節(jié)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.  

      外科醫(yī)生將受破壞的軟骨和骨從脛骨和距骨末端去除，然后將這些骨頭修成合適形狀，調(diào)整它們的位置，使它們排列合適。外科醫(yī)生可能需要在踝關(guān)節(jié)間隙內(nèi)放置骨移植物以利于獲得良好的對(duì)線。如果需要移植物，可以從先前去除的腓骨段獲取。移植物也可以從跟骨或盆骨獲取。

Stabilizing the Ankle（穩(wěn)定踝關(guān)節(jié)）

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.

      一旦骨頭排列合適，外科醫(yī)生用一系列的螺釘、鋼板或兩者結(jié)合起來(lái)對(duì)踝關(guān)節(jié)進(jìn)行固定。這些內(nèi)固定材料將脛骨和距骨連接起來(lái)。當(dāng)這些操作完成后，外科醫(yī)生將切口關(guān)閉，并將腳置于石膏內(nèi)。在接下來(lái)的幾周時(shí)間里，脛骨和距骨會(huì)永久地融合在一起。踝關(guān)節(jié)將不能屈伸活動(dòng)，但會(huì)保留側(cè)向的活動(dòng)。

After Care（術(shù)后護(hù)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.

術(shù)后，經(jīng)過(guò)短期的監(jiān)護(hù)，大多數(shù)患者可以回家。6～8周內(nèi)需要使用拐杖。隨著骨頭逐漸融合，患者的腿可以承受一定的重量。通常在3～6月內(nèi)患者可以恢復(fù)正?；顒?dòng)，在此期間可能需要物理治療。

（胡佰文    譯）