英汉对照骨科患者指南004踝关节镜下
2016-11-30 来源：不详 浏览次数：次SurgicalProcedure
手术过程
Whathappensduringanklearthroscopy?
踝关节镜手术怎么进行？
Beforesurgeryyouwillbeplacedundereithergeneralanesthesiaoratypeofspinalanesthesia.Theanklejointisverytightwithlittlespacebetweenthetibiaandthetalus.Byapplyingtraction,thesurgeonisabletoincreasethisspaceandallowthearthroscopetobeinsertedintothatspace.Theendofthearthroscopewillbemovedaboutinthisspacetolookthroughoutthejoint.Finally,steriledrapesareplacedtocreateasterileenvironmentforthesurgeontowork.ThereisagreatdealofequipmentthatsurroundstheoperatingtableincludingtheTVscreens,cameras,lightsourcesandsurgicalinstr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。
Thesurgeonbeginstheoperationbymakingtwoorthreesmallopeningsintotheankle,calledportals.Theseportalsarewherethearthroscopeandsurgicalinstrumentsareplacedinsidetheankle.Careistakentoprotectthenearbynervesandbloodvessels.Asmallmetalorplastictube(orcannula)willbeplacedthroughoneoftheportalstoinflatetheanklewithsterilesaline.
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。
Thearthroscopeisasmallfiber-optictubethatisusedtoseeandoperateinsidethejoint.Thearthroscopeisasmallmetaltubeabout1/4inchindiameter(slightlysmallerthanapencil)andabout7inchesinlength.ThefiberopticsinsidethemetaltubeofthearthroscopeallowsabrightlightandTVcameratobeconnectedtotheouterendofthearthroscope.Thelightshinesthroughthefiberoptictubeandintotheanklejoint.ATVcameraisattachedtothelensontheouterendofthearthroscope.TheTVcameraprojectstheimagefrominsidetheanklejointonaTVscreennexttothesurgeon.ThesurgeonactuallywatchestheTVscreen(nottheankle)whilemovingthearthroscopetodifferentplacesinsidetheanklejoint.
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。
Overtheyearssincetheinventionofthearthroscope,manyveryspecializedinstrumentshavebeendevelopedtoperformdifferenttypesofsurgeryusingthearthroscopetoseewhatisgoingonwhiletheinstrumentsarebeingused.Today,manysurgicalproceduresthatoncerequiredlargeincisionsforthesurgeontoseeandfixtheproblemcanbedonewithmuchsmallerincisions.Forexample,simpleremovalofaloosebodyintheanklecanbedoneusingtwoorthreesmall1/4inchincisions.Moreextensivesurgicalproceduresmayrequirelargerincisions.Yoursurgeonmaydecideduringtheprocedurethattheproblemrequiresamoretraditionalopentypeoperation.Ifthishasbeendiscussedbeforetheoperationthesurgerymaybeperformedimmediately;ifnot,thearthroscopicprocedurewillbeconcludedandalateroperationplanned.Yoursurgeonwilldiscussthedetailsofwhatwasfoundatthetimeofthearthroscopyandwhatmoreneedstobedoneinthelateroperation.
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。
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