通过这一方法主要是为了修复严重的踝关节关节炎。

This method is mainly used to repair severe ankle arthritis.

1.暴露手术关节

1. exposure of surgical joints

在踝关节外侧取一个独立切口，移除腓骨末端。有时需要在足踝部另一侧取第二个切口以消除内踝突出的骨凸点。这也就是所谓的双向踝关节融合。

Take an independent incision outside the ankle joint to remove the distal fibula. Sometimes second cuts are needed on the other side of the ankle to remove the prominent bumps of the medial malleolus. This is the so-called two-way ankle fusion.

2.移除病骨

2. remove the sick bone.

移除胫骨和距骨末端的受损关节软骨和骨骼，并在局部进行重新对位和塑形。

The injured articular cartilage and bone at the tibia and the end of the talus were removed and repositioned locally.

3.骨补充移植

3. bone graft

骨移植物可以放到任何对位缺口以助于建立正确的对齐。这些移植骨可由手术中被移除的腓骨或跟骨、髋骨中取得。

Bone graft can be placed in any alignment notch to help establish correct alignment. These bone grafts can be obtained from the fibula or calcaneus and hip bone removed during surgery.

4.嵌入螺钉

4. insert screws

以X 射线为指导，外科医生在对位完成后的关节上进行打孔，嵌入2-3 枚螺钉。嵌入方向可由从距骨至胫骨,也可从胫骨至距骨。嵌入的螺钉能够增加骨骼融合过程中的稳定性。

Guided by X-rays, surgeons drill holes into the joints after alignment and insert 2-3 screws. The direction of insertion can be from the talus to the tibia, or from the tibia to the talus. Embedded screws can increase stability during bone fusion.

结束手术

End the operation

正确缝合切口。一段时间后，胫骨、腓骨和距骨融合在一起，使得踝关节不再能够上下移动而只能侧向移动。

Correct suture incision. After a period of time, the tibia, fibula and talus fused together, making the ankle no longer able to move up and down but only lateral.

术后护理

Postoperative nursing

术后6—8 周需要石膏固定和拐杖行走。之后，若骨骼开始融合，可允许局部负重。在10—12 周之后融合进一步稳固，可允许全部负重。患者可在3—6 个月内恢复正常活动，行走时也不会出现跛行或疼痛。

6 to 8 weeks after operation, plaster fixation and walking on crutches are necessary. Then, if the bone begins to merge, partial loading can be allowed. After 10 to 12 weeks, it will further consolidate and allow all full load. The patient can resume normal activity within 3 to 6 months, and there will be no limp or pain when walking.

相关矫形产品：

Related orthopaedic products:

1. 足部矫形器(鞋垫）: 大部分由硬性的材料制成：例如由 Shore A55较硬的EVA 和软木板制成的有较深后跟杯的矫形器；能够更好维持后跟处骨骼位置的HDPP 材料制成的UCBL 足部矫形器。通过后跟提升垫或楔形垫稳定的提升和定位后跟，以获得舒适的步态。

1. Foot orthosis (insoles): Most are made of hard materials: for example, by Shore A55 rigid EVA and cork made of a deeper heel cup orthosis; can better maintain the heel bone position of HDPP material made of UCBL foot orthosis. A comfortable step is achieved by lifting and locating heels with lifting pads or wedge pads.

2. 弓形底鞋(靴): 这类矫形鞋/靴具有更强更长的鞋后帮，能够很好地维持后跟和踝关节的稳定。弓形底鞋/靴的弓形底只要分为：温和弓形底、双弓形底、前掌弓形底和加强弓形底。通过合适的弓形底来调节踝关节融合后的异常步态。这种鞋靴的鞋底必须是硬质的。为了更好的维持踝部的稳定，部分鞋底可能还需要在内外侧进行改造加强。

2. Arch soles (boots): These orthopaedic shoes/boots have stronger and longer uppers and can maintain good heel and ankle stability. The arched soles of arched soles/boots can be divided into mild arched soles, double arched soles, forepalm arched soles and reinforced arched soles. Adjust the abnormal gait after ankle joint fusion by proper arch base. The soles of these boots must be rigid. In order to better maintain the stability of the ankle, some of the soles may need to be rebuilt inside and outside.

3. 糖尿病鞋(靴): 适用于具有糖尿病足并有踝关节骨融合的人群，这类矫形鞋靴的前掌部分内面(前部内里)必须是没有任何接缝，除了鞋底需要弓形底处理外，还必须适配表面附有热塑性材料的糖尿病足专用医护鞋垫。

3. Diabetic footwear (boots): suitable for people with diabetic foot and ankle bone fusion, this kind of orthopedic footwear of the inner part of the forefoot (front inside) must be without any seams, in addition to the sole needs to be arched sole treatment, but also must be adapted to the surface of the thermoplastic material with diabetic foot care insoles.