股骨粗隆间骨折
北京积水潭医院创伤骨科
分型
• • • • • • • • • • Evans' classification (1949) Boyd and Griffin's classification (1949) Ramadier's classification (1956) Decoulx & Lavarde's classification (1969) Ender's classification (1970) Tronzo's classification (1973) Jensen's classification (1975) Deburge's classification (1976) Briot's classification (1980) AO classification (1981)
AO classification
AO classification
• A1: Simple (2-fragment) pertrochanteric area fractures
• A1.1 Fractures along the intertrochanteric line • A1.2 Fractures through the greater trochanter • A1.3 Fractures below the lesser trochanter
分型
• 骨折稳定性评估 • 骨折复位后稳定性评估
• 内固定物选择
• 术后早期部分负重 • 普遍应用
分型
• 解剖学描述 (Evans; Ramadier; Decoulx and Lavarde). • 提示预后 (Tronzo; Ender; Jensen's modification of the Evans grading; Mü et al.). ller
？
DHS GAMMA NAIL
• 头钉位置？
• 头钉深度？
• TAD
头钉位置
• 股骨头颈中心或偏下
• 避免置于后上方


头钉深度
• 位于关节面5-12mm
• 过短


TAD
Tip-Apex Distance
M.R. Baumgaertner, S.L. Curtin, D.1995.
TAD
• A3: Intertrochanteric fractures
• A3.1 Simple, oblique • A3.2 Simple, transverse • A3.3 With a medial fragment
稳定性
• 内侧结构（小粗隆） • 后外侧结构（大粗隆）
股骨粗隆间骨折内固定物选择
Evans' classification
Evans' classification
• Type I: Undisplaced 2-fragment fracture • Type II: Displaced 2-fragment fracture • Type III: 3-fragment fracture without posterolateral support, owing to displacement of greater trochanter fragment • Type IV: 3-fragment fracture without medial support, owing to displaced lesser trochanter or femoral arch fragment • Type V: 4-fragment fracture without posterolateral and medial support (combination of Type III and Type IV) • R: Reversed obliquity fracture
内固定物选择
内固定物选择
内固定物选择
内固定物选择
内固定物选择
• 单钉？Biblioteka • 双钉？内固定物选择
内固定物选择
内固定物选择
后外侧壁
Tronzo's classification (1973)
内固定物选择
M
71ys
谢谢！
• A2: Multifragmentary pertrochanteric fractures
• A2.1 With one intermediate fragment (lesser trochanter detachment) • A2.2 With 2 intermediate fragments • A2.3 With more than 2 intermediate fragments
CUT OUT
CUT OUT
内固定失用（不愈合）
畸形愈合
股骨头缺血坏死
Vicario C, Marco F, Ortega L, Alcobendas M, Dominguez I, Lopez-Duran L. Injury. 2003 Feb;34(2):129-34
内固定物选择
• 髓外？ • 髓内？