医药-股骨干骨折骨折.ppt

股骨干骨折的治疗邓雄伟 胡和军骨八科 创伤骨科 受伤机制 骨折分型 治疗原则 恢复肢体的对线、旋转和长度；? 保存血液供应以促进骨折愈合并防止感染；? 促进患肢及全身的康复。  治疗 保守治疗 骨牵引 手术治疗 钉板类 髓内钉类 外固定 悬吊牵引法 髓内钉 外固定 髓内钉固定 病例二 病例六 钢板固定 新技术 冲洗灌流扩髓器（RIA，Reamer Irrigator Aspirator） 连续扩髓 收集髓内物质用于植骨 Do not discuss nonunion, this will be covered later in the course. Discuss causes of delay in union. Describe the biologic and mechanical condition at the fracture. - Unstable but viable. It is trying to heal, it needs only stability. Describe methods to provide stability at this point. Exchange nailing? Dynamization? * Discuss radiographic and clinical signs and symptoms of bone healing. How does dynamization help? - Allows the bone ends to compress, providing stability which promotes healing. Which end to dynamize and why? - Usually dynamize the screw farthest from the fracture to help maintain stability. * * Results at 18 and 24 weeks postoperative. Describe the radiographic changes. * Ask participants to summarize the case discussion. Discussion points: How do you classify this fracture? – 32-A1 * Discussion points: IM nailing or plate fixation - as often both fixation techniques have pros and cons Reduction techniques? Type of stability? * * * Ask participants to summarize the case discussion. * How would you classify this fracture? Click after each answer to show results: Bone? - femur (3) Segment: Proximal (1), diaphyseal (2), or distal (3)? - diaphyseal (2) What type: Extraarticular (A), partial articular (B), complete articular (C)? - extraarticular (A) Which group: Simple spiral (A1)? Simple oblique (A2)? Simple transverse (A3)? - simple oblique (A2) Classification: 32-A2 * Is reduction adequate? - Yes, reduction of length, rotation and alignment achieved. What is this implant? - LISS fixator How does it function? - As a bridge plate for relative stability. Are these monocortical screws adequate? - Not in osteoporotic bone. Bicortical