Four joint fusion

The Achilles tendon, the distance between the boat and the heel joint, the joint ankle joint (ie, the ankle joint) fusion, called the four joint fusion, also known as talar fusion. There are two approaches: one-stage surgery and staged surgery. Staging surgery is to avoid ischemic necrosis of the talus, but clinical practice has proved that staging surgery is painful, long cycle, and the curative effect is not better than that of the first-stage surgery. Therefore, it advocates one-stage operation. Curing disease: Indication 1, even the foot, the ankle joint is extremely unstable. 2, severe horseshoe varus deformity, more than 170 ° or more. 3, after the three-joint fusion, ankle pain, degenerative changes, traumatic arthritis or ischemic necrosis of the talus. Contraindications 1, 12 years old or younger. 2, the same side of the limb ankle or contralateral limb ankle has been strong. Preoperative preparation Take X-ray films to understand the bone structure and deformity of the whole foot and ankle, and estimate the extent of the osteotomy and the angle of correction during the operation. Surgical procedure 1. The incision is made from 3 to 4 cm above the ankle joint along the lateral aspect of the anterior tibial tendon to the base of the 3rd and 4th tibia. The longitudinal incision is 8 to 10 cm long. Cut the skin and subcutaneous tissue. 2. Cut the deep fascia on the outside of the extensor tendon of the toe and the transverse ligament of the lower leg. Push the soft tissue to both sides to expose the ankle joint and the joint of the scaphoid. The operation should be close to the bone surface to prevent damage to the dorsal artery of the foot. 3, the forefoot adduction and abduction, respectively, cut the joint capsule and ligament around the talus, and then the forefoot extreme plantar flexion, visible talus posterior process. The attached ligament was cut, the talus was pulled out with a periosteal screwdriver, and the cartilage surface of the talus was removed by clamping with a cloth towel. Then, the lower end of the humerus, the cartilage surface above the calcaneus, and the cartilage surface of the scaphoid and tibia are sequentially removed, and the talus is placed back into the acupoint. 4, the foot extension, to maintain the ankle joint back extension, such as the talus and surrounding bones are not close together, can be filled into the chiseled cancellous bone. 5, with a Kirschner wire from the foot through the calcaneus, talus to the lower end of the tibia fixed in the functional position. 6, incision suture to relax the tourniquet, completely stop bleeding, isotonic saline to wash the wound, sutured according to the level.