股骨转子下骨折课件

Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline股骨转子下骨折河南大学淮河医院骨科郭建阔Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline•定义一般是指骨折线在小转子下５ｃｍ范围内、小转子与股骨干峡部之间的骨折Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline最常用的是Ｓｅｉｎｓｈｅｉｍｅｒ分型和Rｕｓｓｅｌｌ－Ｔａｙｌｏｒ分型Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline治疗•几乎都是不稳定，很难复位及固定，保守满意率低，髋内翻、骨不连发生率高。•手术仍是首选Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline手术方式•主要分髓外系统及髓内系统，髓外系统有动力髁钢板(DCS)及股骨近端锁定钢板(LPFP)等;髓内系统内固定有Gamma钉及股骨近端防旋髓内钉(PFNA)Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineGamma钉Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplinePFNAAccordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline锁定板Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline90度角钢板Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineDCSAccordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline•尽管髓内固定生物力学稳定好，切口创伤小，但并没有证实髓内比髓外临床更好。近年来，微创锁定板、ＬＩＳＳ板等临床效果不错。陈松，股骨转子下骨折的手术治疗进展[J］.中国骨与关节杂志，２０１5Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline环扎YesorNo•环扎对血运影响?一些解剖学和组织学研究表明，骨膜血供是环形而非纵向行走(Ｌｅｎ)•环扎的数量及间距有影响。•Ｋｉｍ等经皮环扎髓内固定，均获得愈合，(Ki)Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineGamma钉配合环扎Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplinePFNA术中注意以下几点:1、复位满意是成功的基础2、进针点位置偏外易导致大转子劈裂，偏内从梨状窝进入易造成插入困难•3、长髓内钉更利于应力分散，远端长度建议在骨折端以远5～8cmAccordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline内固定失败Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline翻修••有选择髓内，也有选择髓外的•翻修成功的关键在于，获得解剖复位、提供良好的力学稳定性、植骨及适当的生物学刺激