pfna粗隆間骨折治療課件

PFNA治療股骨粗隆骨折Background股骨粗隆間骨折是老年人的常見病

美國發(fā)病率為0.034%

瑞典發(fā)病率為0.035%中國老齡化，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.DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Background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:CanaleST,BeatyJH.Campbell’sOperativeOrthopaedics[M].9thed.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.DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

A1A2A331-ADepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Classification----AOA1：順粗隆間簡單的兩部分骨折，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Classification----AODepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

A1A2A331–A2/331–A1穩(wěn)定的骨折不穩(wěn)定的骨折年齡、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4早期完全負(fù)重在骨質(zhì)疏松骨有很好的抓持力操作簡單對骨折能進(jìn)行動力加壓置入內(nèi)植物時(shí)避免造成醫(yī)源性骨折保護(hù)骨的血供216345DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

理想的內(nèi)植物所需的條件

1854 Langenbeck1878 Trendelenburg1907 Delbet1925 Smith-Petersen1932 Johannsen/Jerusalem1934 Moore1937 Thorton1940 Küntscher:fem.necknail1942 Brittain1950 Lezius1952 Jewett1954 Küntscher:Y-nail1955 Pohl 1955 Pugh-Massie1955 Ender1965 AO:angledbladeplates1967 Küntscher1967 Simon-Weidner/Ender1967 Zickel1970 Teubner:doubleTplate1980 AO:DHS1988 Kempf:Gamma-Nail1996 Friedl:glidingnail1996AO:PFN股骨近端骨折內(nèi)植物使用的歷史DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

股骨近端骨折生物力學(xué)正常情況下DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

ddm=Fxdm=Fxd股骨近端骨折生物力學(xué)DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

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.靜力加壓與動力加壓雙重功能4.使骨折緊密結(jié)合，促進(jìn)骨折愈合

DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

DynamicHipScrew--

DHSDepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

DynamicHipScrew--

DHS股骨頸長度變短，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

3DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

DHS手術(shù)存在的問題DHS失敗病例DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

DHS失敗病例DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

31—A1：DHS31—A2：PFN31—A3：PFNDepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

BoldinC,etal.Theproximalfemoralnail(PFN)-aminimalinvasivetreatmentofunstableproximalfemoralfractures:aprospectivestudyof55patientswithafollow-upof15months.ActaOrthopScand,2003,74:53-58.2.FlahiffCM,etal.Abiomechanicalevaluationofanintramedullaryfixationdeviceforintertrochantericfractures.JTrauma,1993,35:23-27.3.SadowskiC,etal.Treatmentofreverseobliqueandtransverseintertrochantericfractureswithuseofanintramedullarynailor95°screw-plate.JBoneJointSurg(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.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.中國骨與關(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)定性股骨轉(zhuǎn)子間骨折.中國骨與關(guān)節(jié)損傷雜志,2008,23(12):1015-1017.一個(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DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

PFN-AvsPFN骨科牽引床DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

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DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

鄧X，F(xiàn)emale，81YDepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Case2丁XX，Male，74YDepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Case3DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Male，74YCase5DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Male，81YCase8DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Male，70YCase9Discussion生物力學(xué)：髓內(nèi)系統(tǒng)固定強(qiáng)度明顯優(yōu)于DHS[1]術(shù)后可以早期下床活動

粗隆部粉碎性骨折，進(jìn)針部骨質(zhì)粉碎也適用[2]PFNAReference:FlahiffCM,NelsonCL,GruenwaldJM,etal.Abiomechanicalevaluationofanintramedullaryfixationdeviceforintertrochantericfractures.JTrauma,1993,35:23-27.祝敬華,吳柏林,聶海洋.DHS與PFN在股骨粗隆間骨折中的應(yīng)用.中國骨與關(guān)節(jié)損傷雜志,2006