《股骨粗隆间骨折_》-精选·课件.ppt

股骨粗隆间骨折 分型 Evans classification (1949) Boyd and Griffins classification (1949) Ramadiers classification (1956) Decoulx Lavardes classification (1969) Enders classification (1970) Tronzos classification (1973) Jensens classification (1975) Deburges classification (1976) Briots classification (1980) AO classification (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; Decoulx and Lavarde). 提示预后 (Tronzo; Ender; Jensens modification of the Evans grading; Müller et al.). Evans classification Evans classification Type I: Undisplaced 2-fragment fracture Type II: Displaced 2-fragment fracture Type III: 3-fragment fracture without posterolateral support, owing to displacement of greater trochanter fragment Type IV: 3-fragment fracture without medial support, owing to displaced lesser trochanter or femoral arch fragment Type V: 4-fragment fracture without posterolateral and medial support (combination of Type III and Type IV) R: Reversed obliquity fracture AO classification A1: Simple (2-fragment) pertrochanteric area fractures A1.1 Fractures along the intertrochanteric line A1.2 Fractures through the greater trochanter A1.3 Fractures below the lesser trochanter A2: Multifragmentary pertrochanteric fractures A2.1 With one intermediate fragment (lesser trochanter detachment) A2.2 With 2 intermediate fragments A2.3 With more than 2 intermediate fragments A3: Intertrochanteric fractures A3.1 Simple, oblique A3.2 Simple, transverse A3.3 With a medial fragment 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 DHS GAMMA NAIL 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 TADTip-Apex Distance TAD CUT OUT CUT OUT 内固定失用（不愈合） 畸形愈合 股骨头缺血坏死 Vicario C, Marco F, Ortega L, Alcobendas M, Dominguez I, Lopez-Duran L. Injury. 2003 Feb;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 内固定物选择 内固定物选择 内固定物选择 单钉？ 双钉？ 内固定物选择 内固定物选择 内固定物选择 后外侧壁 内固定物选择 * 北京积水潭医院创伤骨科 AO classification ？ ? ? ? ? M.