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 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 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 CanaleST BeatyJH Campbell sOperativeOrthopaedics M 9thed 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 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences Classification 31 A DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences A1 A2 A3 31 A DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 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 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences A1 A2 A3 31 A2 3 31 A1 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 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 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 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 理想的内植物所需的条件 1854Langenbeck1878Trendelenburg1907Delbet1925Smith Petersen1932Johannsen Jerusalem1934Moore1937Thorton1940K ntscher fem necknail1942Brittain1950Lezius1952Jewett1954K ntscher Y nail 1955Pohl1955Pugh Massie1955Ender1965AO angledbladeplates1967K ntscher1967Simon Weidner Ender1967Zickel1970Teubner doubleTplate1980AO DHS1988Kempf Gamma Nail1996Friedl glidingnail1996AO PFN 股骨近端骨折内植物使用的历史 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 髓内固定 髓外固定 ProximalFemoralNail PFN Gamma NailIntramedullaryHipScrewACE 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 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 股骨近端骨折生物力学 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DynamicHipScrew DHS DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DynamicHipScrew DHS DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DynamicHipScrew DHS DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DHS手术存在的问题 DHS失败病例 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DHS失败病例 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DHS失败病例 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 31 A1 DHS31 A2 PFN31 A3 PFN DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences PFNA螺旋刀片 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences PFN AvsPFN C Arm必不可少 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 骨科牵引床 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences 骨科牵引床 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences Intraoperative 52岁 男性 12months DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences Case1 邓X Female 81Y DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences Case2 丁XX Male 74Y DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences Case3 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences Male 74Y Case5 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences Male 81Y Case8 DepartmentofOrthopedics GuangdongGeneralHospital GuangdongAcademyofMedicalSciences Male 70Y Case9 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