1、Indications 指征This app roach is utilized for poste rior fract ures of the tala r body or poste rio r pr ocess fract ures of the talus. This is a difficult-to-r each anatomical ar ea, and medial or late ral osteotomies do not allow visualization here. A poste romedial app roach pr ovides an adequate view for fixation of fract ures and deb ridement of deb ris.此手术入路适用于距骨体后部骨折或距骨后侧突骨折此区域不容易显露，内侧或外侧截骨，后内侧入路 提供充足的固定骨折和清理碎骨块视野The poste romedial app roach is used rar ely and would expose a fract ure of the poste rior pr ocess of the talus, but would not give visualization of the tala r body, or the subtala r joint. Fr act ures of the body of the talus most often r equi re, par ticula rly if they are more poste rior, an osteotomy of the medial malleolus.后内侧入路通常很少使用，可以显露距骨后突骨折块，但是却无法看见距骨体， 距下关节。
距骨体骨折常常要求，特别是后方骨折块，内踝截骨Cases by courtesy of Dr. Steven Steinlauf, Florida, USA. 上图 Dr. Steven Steinlauf 提供Tibial arteryTibial nerveFlexor hallucis longus tendonAchilles tendonAnatomy 解剖This rar ely-used app roach is ext remely useful and follows the plane between flex or hallucis longus and the Achilles tendon. The neur ovascula r str uct ures lie poste romedially behind the medial malleolus and must be pr otected.此入路沿屈踇长肌和跟腱之间，血管神经束位于内踝的后内侧必须加以保护Posteromedial to the talusTibia I arteryIfbial nerveFlexor hallu匚islongts tendonJAchilJes tendonIncision 切口Skin incision 皮肤切口Using the Achilles as the late ral bounda ry, and the neur ovascula r str uct ures poste romedially, a skin incision is made cente red ove r the subtala r joint using image intensification.把跟腱作为外侧界，血管神经束的后内方，在CB透视下沿距下关节作纵行切口。
Achilles tendonTibial nerveFascia over deep flexor compartmentFlexor halludsIongu5 tendonPosteromedial to the talusSuperficial dissection浅层分离The str uct ures that run behind the medial malleolus are very imp or tant here. The most poste rior str uct ure, flex or hallucis longus, is identified so the sur geon can go poste rior and late ral to it and medial to the Achilles tendon.切口位于屈踇长肌和跟腱Tibial arteryTibi日I nerveDome of tafusPosterior joint —; capsule- Flexor h-allu匚i百 A ScngusPosteromedial to the tusDeep dissection 深层分离The tendon sheath of the flex or hallucis longus must be opened. This allows the retr action of the tendon togethe r with the neur ovascula r bundle and gains expos ure of the fract ure.Late ral to the tendon sheath of the FHL is the poste rior tube rcle of the talus.The sur geon must be car eful not to be too pr oximal and mistake the distal tibia for the talus. Fixation and deb ridement can now be completed.打开屈踇长肌腱鞘，这就可以牵开神经血管束并获得骨折端的显露。
屈踇长肌肌腱鞘外侧是距骨后结节手术必须小心不要靠上，以免把胫骨认为是距骨，确认距骨后固定和清除碎骨块就可以开始了。