1、適應(yīng)證 IndicationsThemedialutilityincisioncanbeusedtoapproachanyofthemedialstructuresofthefoot,includingtendons,jointsandbones.Theincisioncanpotentiallyextendfromthegreattoealongthemedialcolumntothebackofthetalus.Mostoften,weuseonlyaportionoftheoveraillengthofthisapproach.內(nèi)側(cè)實(shí)用切口可用于足內(nèi)側(cè)結(jié)構(gòu)包括肌腱、關(guān)節(jié)和骨；切口可以向遠(yuǎn)端延伸至第1趾骨，向近端可延伸至距骨。通常我們僅僅使用這個(gè)切口的一部分。2、解剖AnatomyThemedialutilityincisionisinasafeplanebetweentheposteriortibialisandtheanteriortibialis.Therearenomajorneurovascularstructuresinthisregion.Superficialsmallveinscanbecauterizedduringtheapproach.此切口位于脛骨前肌和脛骨后肌之間，此區(qū)域沒(méi)有重要神經(jīng)血管組織，注意淺靜脈保護(hù)。

■Iy:LateralplantararteryandnervePosteriortibiolartery ■Iy:LateralplantararteryandnervePosteriortibiolartery cafcanealbranchoftibialnervePosteriorTibialtendon Anteriortibialtendon ReAordigitorumlangue Extensorhalluci^加gus 、Superficialbranchof、 .-丿medialplantardrtery\ 舟plantarartery^rtdnerveMASTERKNOTOFHENRY/ /FlexorhallucisIongus〔.Posteriortibialartery 脛后動(dòng)脈Medialcalcanealbranchoftibialnerve脛神經(jīng)跟骨內(nèi)側(cè)分支Posteriortibialtendon 脛后肌腱Anteriortibialtendon 脛前肌腱flexordigitorumlongus 屈趾長(zhǎng)肌Extensorhallucislongus 伸拇長(zhǎng)肌7.SuperficialbranchofmedialplantararteryMedialplantararteryandnerveMaterknotofhenry 屈趾長(zhǎng)肌和屈拇長(zhǎng)肌肌腱交叉處Flexorharllucislongus11丄ateralplanterarteryandnerve3、皮膚切口SkinincisionForthemedialapproachtothenavicular,theareaalongthemedialutilityincisionoverthenavicularisused.Theincisioncanbeextendedproximallytoallowaccesstothetalonavicularjoint,ordistallyforaccesstothecuneiforms,firstmetatarsalbaseandnaviculo-cuneiformandintertarsaljoints.內(nèi)踝下至距舟關(guān)節(jié)至舟楔關(guān)節(jié)至第1跖骨基底。Theanteriortibialistendoncanbefoundatitsinsertiononthemedialcuneiformorthebaseofthefirstmetatarsal.ThemasterknotofHenrycanbefoundplantartothecuneiform,wheretheflexordigitorumIongus(FDL)andflexorhallucislongus(FHL)cross.切開(kāi)可見(jiàn)脛前肌止于內(nèi)側(cè)楔骨或第1跖骨基底，Henry結(jié)位于楔骨處(屈趾長(zhǎng)肌和屈拇長(zhǎng)肌肌腱交叉處)4、背內(nèi)側(cè)切口AdditionaldorsomedialincisionIfthereisanavicularfracturewithcomminutionandlossofthearchitectureofthenavicularpartofthetalo-navicularjoint,thenadorsomedialincisionmaybeusedtoproperlyreconstructtheshapeofthenavicular.Iffracturecarerequiresamoreextensileapproach,theadvantagesofbetter

reductionarebalaneedagainstwiderdissectioncausingstripping/lossofbloodsupplywhichmayimpedehealing.Ifthedorsomedialapproachisrequired,careshouldbetakentominimizedissection.詳細(xì)見(jiàn)足舟骨背內(nèi)側(cè)切口專題MedialdorsalCLitaneousnerveDeepfibulartie『甘乜AnteriortibialarteryExtensorhallucisiongusIntermediatedorsaltutaneou5nerveTibi詁唇anteriortendon5、關(guān)閉死腔ClosingthedeadspaceThemedialutilityincisioncanbeclosedinlayers.Afewdeepstitchesherecanclosetheplantarmedialspacethatmayhaveresultedfromthedissection,especiallywhe