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1、Indications 指征The an teromedial approach is usually employed in comb in ati on with the an terolateral approach in order to obta in an an atomic reducti on of displaced and commi nu ted fractures.前内入路通常与前外入路联合应用，以便对距骨获得解剖复位。In the less commo n situati on where the fracture of the talar n eck is not
2、comm inu ted, one can obta in an an atomic reducti on and fixati on using only the an teromedial approach.少数情况下，当距骨颈不是粉碎骨折，可以使用单纯前内入路获得解剖复位和固定。Antertor tibial arteryAnatomy 解剖One must not damage the blood supply to the talus. The n eck of the talus receives bra nches from the medial and lateral side
3、. The body of the talus is supplied almost exclusively from its posteromedial aspect.必须避免损伤距骨血供，距骨颈血运来自内侧和外侧面，距骨体则由后正中单独 供应。Anteromedial to the taEusMedial Mor爭耳I 匚utdieous nervExtens-or haEhcis- longueDeep fibular nerveTibialis anterior 一 tendonDorsal pedl arteryI intermediate dorsal cutaneous nerv
4、eAntEremedial to the tIusMedial matleolar branchesPosterior tibial arterySuperffcil branch of medial dI目nts0Medial plantar artery and nerwLateral plantar artery and nerveThe an teromedial approach avoids these two n eurovascular bun dies and provides access to the medial talus and surro unding join
5、ts.入路应避免两个神经血管束（隐神经大隐静脉束/胫后神经血管束），显露距骨内侧和周围 关节MedraE calcaneal branchOf tibial nerveSkin incision 皮肤切口This incision runs from the medial malleolus proximally to the base of the first metatarsal distally.For more complex fractures the in cisi on may be exte nded proximally.切口起自内踝下级至第一跖骨基底。多数复杂骨折可能需要显
6、露下极。Anteramediat to the tatusIt is most importa nt not to damage the deltoid bra nches which arise posteromedially and supply the medial two thirds of the talar body.不要损伤从后内侧分出供应距骨体2/3部分血管分支。JLong saphenous vein and saphenous nerveExtensor retinaculumExposure of the anteromedial talar neck显露前内侧距骨颈On
7、ce skin and fascia are in cised, one encoun ters the fracture hematoma which should be evacuated in order to expose the un derly ing in fero-medial aspect of the n eck, and the fracture.切开皮肤和筋膜后，清除骨折端血肿，显露下面距骨颈下内侧面和骨折。The arrow points to a simple fracture of the talar n eck, which is less comm on.下图
8、显示个简单距骨颈骨折，这个损伤很少见。Anteromedist to the talusDebridement of subtalar joint 切开距下关节The fractures on the medial side are ofte n multifragme ntary. Fragme nts which are displaced into the subtalar joint must be debrided to allow an an atomic reducti on of the subtalar joint.内侧面骨折都通常都是复杂骨折，骨折块落入距下关节必须被清除，以便解剖复位距下关节。Restorati on of le ngth, if the fracture is comm inu ted, depe nds on an atomic reducti on of the lateral aspect of the talar n eck.如果骨折是复杂的，距骨外侧面解剖复位可以恢复距骨长度。
