fna粗隆間骨折治療課件

1、PFNA治療股骨粗隆骨折fna粗隆間骨折治療1PFNAfna粗隆間骨折治療1Background股骨粗隆間骨折是老年人的常見(jiàn)病 美國(guó)發(fā)病率為0.034% 瑞典發(fā)病率為0.035% 中國(guó)老齡化，發(fā)病率不低于以上數(shù)字 Reference:雍宜民. 實(shí)用骨科臨床M . 北京: 科學(xué)技術(shù)文獻(xiàn)出版社, 1999: 188-198.Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療2Background股骨粗隆間骨折是老年人的常見(jiàn)病 美國(guó)發(fā)病Back

2、ground 病死率較高，大約10%20%在骨折后1年內(nèi)死亡主要死因?yàn)榕P床后出現(xiàn)的內(nèi)科并發(fā)癥有心血管疾病和高齡患者的病死率比其他人高一倍 References:Canale ST, Beaty JH. Campbells Operative Orthopaedics M. 9th ed. Harcourt: Mosby, 1998: 2182-2199.張慶明, 沈惠良, 雍宜民, 等. 經(jīng)皮鈦合金空心釘治療高齡老年人粗隆間骨折. 骨與關(guān)節(jié)損傷雜志, 2002, 17(5) : 332-334. Department of Orthopedics , Guangdong General Hos

3、pital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療3Background 病死率較高，大約10%20%在骨折后Classification31 - A 32：股骨干 31：股骨近端31：股骨遠(yuǎn)端31 B：關(guān)節(jié)囊內(nèi)的股骨頸骨折31 A：關(guān)節(jié)囊外的轉(zhuǎn)子間骨折31 A：關(guān)節(jié)囊內(nèi)的股骨頭骨折AODepartment of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療4Classification31 - A

4、32：股骨干 3A 1A 2A 331-ADepartment of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences Classification - AOA1：順粗隆間簡(jiǎn)單的兩部分骨折，內(nèi)側(cè)有良好的骨皮質(zhì)支撐A2：粗隆間粉碎性骨折，內(nèi)側(cè)和后方破裂，外側(cè)骨皮質(zhì)完好A3：外側(cè)骨皮質(zhì)破裂，逆轉(zhuǎn)之間骨折fna粗隆間骨折治療5A 1A 2A 331-ADepartment of OrtClassification - AODepartment of Orthopedics , Guangdo

5、ng General Hospital, Guangdong Academy of Medical Sciences A1A2A3fna粗隆間骨折治療6Classification - AODepartme31 A2/331 A 1穩(wěn)定的骨折不穩(wěn)定的骨折fna粗隆間骨折治療731 A2/331 A 1穩(wěn)定的骨折不穩(wěn)定的骨折fn Background 手 術(shù) 治 療保守治療牽引保守治療防旋鞋Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療

6、8 Background 手 術(shù) 治 療保守治年齡、健康狀況骨的質(zhì)量骨折的幾何力學(xué)影響治療的因素 復(fù)位 內(nèi)植物的選擇 內(nèi)植物的準(zhǔn)確放置不可控制因素可控制因素fna粗隆間骨折治療9年齡、健康狀況影響治療的因素 復(fù)位不可控制因素可控制因素fn4早期完全負(fù)重在骨質(zhì)疏松骨有很好的抓持力操作簡(jiǎn)單對(duì)骨折能進(jìn)行動(dòng)力加壓置入內(nèi)植物時(shí)避免造成醫(yī)源性骨折保護(hù)骨的血供216345Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences 理想的內(nèi)植物所需的條件fna粗隆間骨折治療104早期

7、完全負(fù)重在骨質(zhì)疏松骨有很好的抓持力操作簡(jiǎn)單對(duì)骨折能進(jìn)行1854Langenbeck1878Trendelenburg1907Delbet1925Smith-Petersen1932Johannsen/Jerusalem1934Moore1937Thorton1940Kntscher: fem.neck nail1942Brittain1950Lezius1952Jewett1954Kntscher: Y-nail1955Pohl1955Pugh-Massie1955Ender1965AO: angled blade plates1967Kntscher1967Simon-Weidner/End

8、er1967Zickel1970Teubner: double T plate1980AO: DHS1988Kempf : Gamma-Nail1996Friedl: gliding nail1996 AO: PFN股骨近端骨折內(nèi)植物使用的歷史Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療111854Langenbeck1955Pohl股骨近Department of Orthopedics , Guangdong General H

9、ospital, Guangdong Academy of Medical Sciences 髓內(nèi)固定髓外固定 Proximal Femoral Nail ( PFN ) Gamma - Nail Intramedullary Hip Screw ACE - Nail 股骨髁角鋼板 DHS, CHS, DCS股骨近端骨折內(nèi)植物分類fna粗隆間骨折治療12Department of Orthopedics , Gu股骨近端骨折生物力學(xué)正常情況下Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of

10、Medical Sciences fna粗隆間骨折治療13股骨近端骨折生物力學(xué)正常情況下Department of Oddm = F x d m = F x d 股骨近端骨折生物力學(xué)Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療14ddm = F x d m = F x d 股骨近端骨折生物1. DHS是最具代表性的髓外釘板系統(tǒng)2. 適合于大多數(shù)股骨粗隆間骨折 3. 靜力加壓與動(dòng)力加壓雙重功能4. 使骨折緊密結(jié)合，促進(jìn)骨折愈合 Dep

11、artment of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences Dynamic Hip Screw - DHSfna粗隆間骨折治療151. DHS是最具代表性的髓外釘板系統(tǒng)2. 適合于大多數(shù)股骨Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences Dynamic Hip Screw - DHSfna粗隆間骨折治療16Department of O

12、rthopedics , GuDepartment of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences Dynamic Hip Screw - DHSfna粗隆間骨折治療17Department of Orthopedics , Gu股骨頸長(zhǎng)度變短，肢體短縮 1粉碎性不穩(wěn)定骨折，后內(nèi)側(cè)骨質(zhì)缺損 2骨折線位于DHS 進(jìn)針處時(shí)也不適用 3Department of Orthopedics , Guangdong General Hospital, Guangdong Academy o

13、f Medical Sciences DHS手術(shù)存在的問(wèn)題fna粗隆間骨折治療18股骨頸長(zhǎng)度變短，肢體短縮 1粉碎性不穩(wěn)定骨折，后內(nèi)側(cè)骨質(zhì)缺損DHS失敗病例Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療19DHS失敗病例Department of OrthopediDHS失敗病例Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Me

14、dical Sciences fna粗隆間骨折治療20DHS失敗病例Department of OrthopediDHS失敗病例Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療21DHS失敗病例Department of Orthopedi31A1：DHS31A2：PFN31A3：PFNDepartment of Orthopedics , Guangdong General Hospital, Guangdong Academy of

15、 Medical Sciences Boldin C, et al. The proximal femoral nail (PFN)-a minimal invasive treatment of unstable proximal femoral fractures: a prospective study of 55 patients with a follow-up of 15 months. Acta Orthop Scand, 2003, 74: 53-58.2. Flahiff CM, et al. A biomechanical evaluation of an intramed

16、ullary fixation device for intertrochanteric fractures. J Trauma, 1993, 35: 23-27.3. Sadowski C, et al. Treatment of reverse oblique and transverse intertrochanteric fractures with use of an intramedullary nail or 95 screw- plate. J Bone Joint Surg(Br), 2002, 84: 372- 381.4. 張經(jīng)緯, 等. 股骨轉(zhuǎn)子間骨折不同手術(shù)方法比較.

17、中華骨科雜志, 2005, 25: 7- 11. 5. 盧華定, 等. 股骨近端髓內(nèi)釘在股骨轉(zhuǎn)子周圍骨折中的應(yīng)用. 中國(guó)骨與關(guān)節(jié)損傷雜志, 2005, 20(4): 246-248.6. 姜磊, 等. 閉合復(fù)位PFN治療高齡股骨粗隆間骨折的體會(huì). 中國(guó)骨與關(guān)節(jié)損傷雜志, 2006, 21(1): 59-60.7. 祝敬華, 等. DHS與PFN在股骨粗隆間骨折中的應(yīng)用. 中國(guó)骨與關(guān)節(jié)損傷雜志, 2006, 21: 63-64.8. 范忠明, 等. PFNA治療老年股骨粗隆間骨折. 中國(guó)骨與關(guān)節(jié)損傷雜志, 2009, 24(2): 151-153.9. 周建華, 等. PFNA治療老年不穩(wěn)定性股

18、骨轉(zhuǎn)子間骨折. 中國(guó)骨與關(guān)節(jié)損傷雜志, 2008, 23(12): 1015-1017. fna粗隆間骨折治療2231A1：DHSDepartment of Orthope一個(gè)部件即完成了抗旋轉(zhuǎn)及成角穩(wěn)定性 末端寬大的刀面盡可能多的壓縮周圍骨質(zhì)，尤其是在骨質(zhì)疏松的情況下，具有更好的抓持力 PFNA螺旋刀片和骨質(zhì)貼合緊密，增強(qiáng)了穩(wěn)定性，防止旋轉(zhuǎn)和內(nèi)翻畸形 生物力學(xué)試驗(yàn)證明: 螺旋刀片顯著提高抗切出能力PFNA 螺旋刀片Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Scien

19、ces PFN-A vs PFNfna粗隆間骨折治療23一個(gè)部件即完成了抗旋轉(zhuǎn)及成角穩(wěn)定性 PFNA 螺旋刀片DepCArm 必不可少Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療24CArm 必不可少Department of Orthop骨科牽引床Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences

20、 fna粗隆間骨折治療25骨科牽引床Department of Orthopedics骨科牽引床123骨折基本或部分閉合復(fù)位向健側(cè)傾斜，掌握前傾角內(nèi)收、內(nèi)旋患肢，糾正畸形Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences fna粗隆間骨折治療26骨科牽引床123骨折基本或部分閉合復(fù)位向健側(cè)傾斜，掌握前傾角Department of Orthopedics , Guangdong General Hospital, Guangdong Academy of Me

21、dical Sciences Intraoperative fna粗隆間骨折治療27Department of Orthopedics , Gu52 歲，男性12 monthsDepartment of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences Case 1fna粗隆間骨折治療2852 歲，男性12 monthsDepartment of 鄧X，F(xiàn)emale，81YDepartment of Orthopedics , Guangdong General Hospital, G

22、uangdong Academy of Medical Sciences Case 2fna粗隆間骨折治療29鄧X，F(xiàn)emale，81YDepartment of Ort丁XX，Male，74YDepartment of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences Case 3fna粗隆間骨折治療30丁XX，Male，74YDepartment of OrthDepartment of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences Male，74YCase 5fna粗隆間骨折治療31Department of Orthopedics , GuDepartment of Orthopedics , Guangdong General Hospital, Guangdong Academy of Medical Sciences Male，81YCase 8fna粗隆間骨折治療32Department of Orthopedics , GuDepartment of Orthopedics , Guangdong General Hospital, Guan