培训课件--PFNA粗隆间骨折治疗.ppt

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，进针部骨质粉碎也适用[2] PFNA Reference: Flahiff CM, Nelson CL, Gruenwald JM, et al. A biomechanical evaluation of an intramedullary fixation device for intertrochanteric fractures. J Trauma, 1993, 35: 23-27. 祝敬华, 吴柏林, 聂海洋. DHS与PFN在股骨粗隆间骨折中的应用. 中国骨与关节损伤杂志, 2006, 21:63-64. Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences 术中应注意正确的颈干角、前倾角 1 螺钉退出、切割股骨头 2 髋内翻畸形——进钉点的选择 3 Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences PFNA手术存在的问题 This figure shows stable and unstable fractures, that is 31-A1 is classified into stable fracture and 31-A2 and A3 is unstable fracture. A moment equal force by distances. So, nail is more advantageous than DHS because of short lever arm. But PFNA 治疗股骨粗隆骨折 Background 股骨粗隆间骨折是老年人的常见病 美国发病率为0.034% 瑞典发病率为0.035% 中国老龄化，发病率不低于以上数字 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. Campbell’s 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 32：股骨干 31：股骨近端 31：股骨远端 31 – B：关节囊内的股骨颈骨折 31 – A：关节囊外的转子间骨折 31 – A：关节囊内的股骨头骨折 AO 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