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 probl

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。