pfna粗隆间骨折治疗课件

PFNA治疗股骨粗隆骨折Background股骨粗隆间骨折是老年人的常见病

美国发病率为0.034%

瑞典发病率为0.035%中国老龄化，发病率不低于以上数字

Reference:雍宜民.实用骨科临床[M].北京:科学技术文献出版社,1999:188-198.DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Background病死率较高，大约10%～20%在骨折后1年内死亡主要死因为卧床后出现的内科并发症有心血管疾病和高龄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.张庆明,沈惠良,雍宜民,等.经皮钛合金空心钉治疗高龄老年人粗隆间骨折.骨与关节损伤杂志,2002,17(5):332-334.DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

A1A2A331-ADepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Classification----AOA1：顺粗隆间简单的两部分骨折，内侧有良好的骨皮质支撑A2：粗隆间粉碎性骨折，内侧和后方破裂，外侧骨皮质完好A3：外侧骨皮质破裂，逆转之间骨折Classification----AODepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

A1A2A331–A2/331–A1稳定的骨折不稳定的骨折年龄、健康状况骨的质量骨折的几何力学影响治疗的因素

复位

内植物的选择

内植物的准确放置不可控制因素可控制因素4早期完全负重在骨质疏松骨有很好的抓持力操作简单对骨折能进行动力加压置入内植物时避免造成医源性骨折保护骨的血供216345DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

理想的内植物所需的条件

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股骨近端骨折内植物使用的历史DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

股骨近端骨折生物力学正常情况下DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

ddm=Fxdm=Fxd股骨近端骨折生物力学DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

1.DHS是最具代表性的髓外钉板系统2.适合于大多数股骨粗隆间骨折

3.静力加压与动力加压双重功能4.使骨折紧密结合，促进骨折愈合

DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

DynamicHipScrew--

DHSDepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

DynamicHipScrew--

DHS股骨颈长度变短，肢体短缩

1粉碎性不稳定骨折，后内侧骨质缺损

2骨折线位于DHS进针处时也不适用

3DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

DHS手术存在的问题DHS失败病例DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

DHS失败病例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.张经纬,等.股骨转子间骨折不同手术方法比较.中华骨科杂志,2005,25:7-11.5.卢华定,等.股骨近端髓内钉在股骨转子周围骨折中的应用.中国骨与关节损伤杂志,2005,20(4):246-248.6.姜磊,等.闭合复位PFN治疗高龄股骨粗隆间骨折的体会.中国骨与关节损伤杂志,2006,21(1):59-60.7.祝敬华,等.DHS与PFN在股骨粗隆间骨折中的应用.中国骨与关节损伤杂志,2006,21:63-64.8.范忠明,等.PFNA治疗老年股骨粗隆间骨折.中国骨与关节损伤杂志,2009,24(2):151-153.9.周建华,等.PFNA治疗老年不稳定性股骨转子间骨折.中国骨与关节损伤杂志,2008,23(12):1015-1017.一个部件即完成了抗旋转及成角稳定性末端宽大的刀面尽可能多的压缩周围骨质，尤其是在骨质疏松的情况下，具有更好的抓持力PFNA螺旋刀片和骨质贴合紧密，增强了稳定性，防止旋转和内翻畸形生物力学试验证明:螺旋刀片显著提高抗切出能力PFNA螺旋刀片DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

PFN-AvsPFN骨科牵引床DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

骨科牵引床123骨折基本或部分闭合复位向健侧倾斜，掌握前倾角内收、内旋患肢，纠正畸形DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

邓X，Female，81YDepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

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

Case3DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Male，74YCase5DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Male，81YCase8DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences

Male，70YCase9Discussion生物力学：髓内系统固定强度明显优于DHS[1]术后可以早期下床活动

粗隆部粉碎性骨折，进针部骨质粉碎也适用[2]PFNAReference:FlahiffCM,NelsonCL,GruenwaldJM,etal.Abiomechanicalevaluationofanintramedullaryfixationdeviceforintertrochantericfractures.JTrauma,1993,35:23-27.祝敬华,吴柏林,聂海洋.DHS与PFN在股骨粗隆间骨折中的应用.中国骨与关节损伤杂志,2006