fna粗隆间骨折治疗.ppt

PFNA 治疗股骨粗隆骨折,Background,Reference: 雍宜民. 实用骨科临床M . 北京: 科学技术文献出版社, 1999: 188-198.,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Background,病死率较高，大约10%20%在骨折后1年内死亡 主要死因为卧床后出现的内科并发症 有心血管疾病和高龄患者的病死率比其他人高一倍,References: Canale ST, Beaty JH. Campbells Operative Orthopaedics M. 9th ed. Harcourt: Mosby, 1998: 2182-2199. 张庆明, 沈惠良, 雍宜民, 等. 经皮钛合金空心钉治疗高龄老年人粗隆间骨折. 骨与关节损伤杂志, 2002, 17(5) : 332-334.,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Classification,31 - A,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,A 1,A 2,A 3,31-A,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Classification - AO,A1：顺粗隆间简单的两部分骨折，内侧有良好的骨皮质支撑 A2：粗隆间粉碎性骨折，内侧和后方破裂，外侧骨皮质完好 A3：外侧骨皮质破裂，逆转之间骨折,Classification - AO,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,A1,A2,A3,31 A2/3,31 A 1,稳定的骨折,不稳定的骨折,Background,手 术 治 疗,保守治疗牵引,保守治疗防旋鞋,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,年龄、健康状况 骨的质量 骨折的几何力学,影响治疗的因素,复位 内植物的选择 内植物的准确放置,不可控制因素,可控制因素,4,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,理想的内植物所需的条件,1854 Langenbeck 1878 Trendelenburg 1907 Delbet 1925 Smith-Petersen 1932 Johannsen/Jerusalem 1934 Moore 1937 Thorton 1940 Kntscher: fem.neck nail 1942 Brittain 1950 Lezius 1952 Jewett 1954 Kntscher: Y-nail,1955 Pohl 1955 Pugh-Massie 1955 Ender 1965 AO: angled blade plates 1967 Kntscher 1967 Simon-Weidner/Ender 1967 Zickel 1970 Teubner: double T plate 1980 AO: DHS 1988 Kempf : Gamma-Nail 1996 Friedl: gliding nail 1996 AO: PFN,股骨近端骨折内植物使用的历史,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,髓内固定,髓外固定,Proximal Femoral Nail ( PFN ) Gamma - Nail Intramedullary Hip Screw ACE - Nail,股骨髁角钢板 DHS, CHS, DCS,股骨近端骨折内植物分类,股骨近端骨折生物力学,正常情况下,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,股骨近端骨折生物力学,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Dynamic Hip Screw - DHS,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Dynamic Hip Screw - DHS,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Dynamic Hip Screw - DHS,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,DHS手术存在的问题,DHS失败病例,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,DHS失败病例,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,DHS失败病例,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,31A1：DHS 31A2：PFN 31A3：PFN,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,PFNA 螺旋刀片,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,PFN-A vs PFN,CArm 必不可少,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,骨科牵引床,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,骨科牵引床,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Intraoperative,52 岁，男性,12 months,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Case 1,邓X，Female，81Y,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Case 2,丁XX，Male，74Y,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Case 3,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Male，74Y,Case 5,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Male，81Y,Case 8,Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences,Male，70Y,Case 9,Discussion,生物力学：髓内系统固定强度明显优于DHS 1,术后可以早期下床活动,粗隆部粉碎性