PFNA粗隆间骨折治疗

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,1854Langenbeck1878Trendelenburg1907Delbet1925Smith-Petersen1932Johannsen/Jerusalem1934Moore1937Thorton1940Kntscher: fem.neck nail1942Brittain1950Lezius1952Jewett1954Kntscher: Y-nail,1955Pohl1955Pugh-Massie1955Ender1965AO: angled blade plates1967Kntscher1967Simon-Weidner/Ender1967Zickel1970Teubner: double T plate1980AO: DHS1988Kempf : Gamma-Nail1996Friedl: gliding nail1996 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：DHS31A2：PFN31A3：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,粗隆部粉碎性骨折，