股骨粗隆间骨折-4

股骨粗隆间骨折北京积水潭医院创伤骨科分型Evans'classification(1949)BoydandGriffin'sclassification(1949)Ramadier'sclassification(1956)Decoulx&Lavarde'sclassification(1969)Ender'sclassification(1970)Tronzo'sclassification(1973)Jensen'sclassification(1975)Deburge'sclassification(1976)Briot'sclassification(1980)AOclassification(1981)分型骨折稳定性评估骨折复位后稳定性评估内固定物选择术后早期部分负重普遍应用分型解剖学描述(Evans;Ramadier;DecoulxandLavarde).提示预后(Tronzo;Ender;Jensen'smodificationoftheEvansgrading;Mülleretal.).Evans'classificationEvans'classificationTypeI:Undisplaced2-fragmentfractureTypeII:Displaced2-fragmentfractureTypeIII:3-fragmentfracturewithoutposterolateralsupport,owingtodisplacementofgreatertrochanterfragmentTypeIV:3-fragmentfracturewithoutmedialsupport,owingtodisplacedlessertrochanterorfemoralarchfragmentTypeV:4-fragmentfracturewithoutposterolateralandmedialsupport(combinationofTypeIIIandTypeIV)R:Reversedobliquityfracture

AOclassificationAOclassification

A1:Simple(2-fragment)pertrochantericareafracturesA1.1FracturesalongtheintertrochantericlineA1.2FracturesthroughthegreatertrochanterA1.3FracturesbelowthelessertrochanterA2:MultifragmentarypertrochantericfracturesA2.1Withoneintermediatefragment(lessertrochanterdetachment)A2.2With2intermediatefragmentsA2.3Withmorethan2intermediatefragmentsA3:IntertrochantericfracturesA3.1Simple,obliqueA3.2Simple,transverseA3.3Withamedialfragment稳定性内侧结构（小粗隆）后外侧结构（大粗隆）股骨粗隆间骨折内固定物选择？DHSGAMMANAIL头钉位置？头钉深度？TAD头钉位置股骨头颈中心或偏下避免置于后上方

头钉深度位于关节面5-12mm过短

TAD

Tip-ApexDistanceM.R.Baumgaertner,S.L.Curtin,D.1995.TADCUTOUTCUTOUT内固定失用（不愈合）畸形愈合股骨头缺血坏死VicarioC,MarcoF,OrtegaL,AlcobendasM,DominguezI,Lopez-DuranL.Injury.2003Feb;34(2):129-34内固定物选择髓外？髓内？内固定物选择内固定物选择内固定物选