股骨粗隆間骨折-4

股骨粗隆間骨折北京積水潭醫(yī)院創(chuàng)傷骨科分型Evans'classification(1949)BoydandGriffin'sclassification(1949)Ramadier'sclassification(1956)Decoulx&Lavarde'sclassification(1969)Ender'sclassification(1970)Tronzo'sclassification(1973)Jensen'sclassification(1975)Deburge'sclassification(1976)Briot'sclassification(1980)AOclassification(1981)分型骨折穩(wěn)定性評估骨折復(fù)位后穩(wěn)定性評估內(nèi)固定物選擇術(shù)后早期部分負重普遍應(yīng)用分型解剖學描述(Evans;Ramadier;DecoulxandLavarde).提示預(yù)后(Tronzo;Ender;Jensen'smodificationoftheEvansgrading;Mülleretal.).Evans'classificationEvans'classificationTypeI:Undisplaced2-fragmentfractureTypeII:Displaced2-fragmentfractureTypeIII:3-fragmentfracturewithoutposterolateralsupport,owingtodisplacementofgreatertrochanterfragmentTypeIV:3-fragmentfracturewithoutmedialsupport,owingtodisplacedlessertrochanterorfemoralarchfragmentTypeV:4-fragmentfracturewithoutposterolateralandmedialsupport(combinationofTypeIIIandTypeIV)R:Reversedobliquityfracture

AOclassificationAOclassification

A1:Simple(2-fragment)pertrochantericareafracturesA1.1FracturesalongtheintertrochantericlineA1.2FracturesthroughthegreatertrochanterA1.3FracturesbelowthelessertrochanterA2:MultifragmentarypertrochantericfracturesA2.1Withoneintermediatefragment(lessertrochanterdetachment)A2.2With2intermediatefragmentsA2.3Withmorethan2intermediatefragmentsA3:IntertrochantericfracturesA3.1Simple,obliqueA3.2Simple,transverseA3.3Withamedialfragment穩(wěn)定性內(nèi)側(cè)結(jié)構(gòu)（小粗?。┖笸鈧?cè)結(jié)構(gòu)（大粗隆）股骨粗隆間骨折內(nèi)固定物選擇？DHSGAMMANAIL頭釘位置？頭釘深度？TAD頭釘位置股骨頭頸中心或偏下避免置于后上方

頭釘深度位于關(guān)節(jié)面5-12mm過短

TAD

Tip-ApexDistanceM.R.Baumgaertner,S.L.Curtin,D.1995.TADCUTOUTCUTOUT內(nèi)固定失用（不愈合）畸形愈合股骨頭缺血壞死VicarioC,MarcoF,OrtegaL,AlcobendasM,DominguezI,Lopez-DuranL.Injury.2003Feb;34(2):129-34內(nèi)固定物選擇髓外？髓內(nèi)？內(nèi)固定物選擇內(nèi)固定物選擇內(nèi)固定物選