PFNA与Gamma3治疗不稳定股骨粗隆间骨折的疗效评价.ppt

结 果 * * * A1型:粗隆部位骨折,简单经粗隆 A1.1延粗隆间线 A1.2通过大粗隆 A1.3小粗隆下 * * * * The next step was to change to an intramedullary device. In comparison to a plate, an intramedullary nail is placed in the axis of the bone which brings a better transmission of the loads. On the other hand, this central position of the nail will prevent an over-dynamisation of neck-head fragment, as well as it offers an stronger construct (shorter lever arm). * Our experience at that time with IM nail design suggested that it was possible to combine the biomechanical advantages of an IM nail with those of a compression hip screw. In essence the implant had to have a suitable IM design to enable the closed technique of implantation that had been developed through IM nailing. In addition the device had to enable transfer of hip loads via the lag screw and nail to the shaft of the femur whilst at the same time withstanding the large and very dynamic bending and torsional loading. Dynamic Torsional Loads Large Dynamic Loads Dynamic Bending Loads * The indication for the TGN are : Intertrochanteric, Pertrochanteric, High-subtrochanteric fractures. The indication for the LGN are : Spiralling subtrochanteric fractures, Pertrochanteric fractures associated with shaft fractures, Pathological fractures, Prophylactic treatment, Proximal or distal non-unions and mal- unions, * Gamma钉由于尾端较PFN短，由于应力集中可能会导致股骨干骨折。而PFN由于尾端较长，从而避免了股骨干骨折的可能。 * * In this situation, the two hip screws interfere with the sliding, and this leads to the cut-out effect. (slide show a PFN) * Technically, it is more demanding to correctly introduce two screws in the femoral neck. Clinically, two screws may affect the quality of the bone support. (slide show the PFN design concept) * From a biomechanical point of view, two screws may affect the mechanical behaviour of the implant. In the case one of the screw bended over load, it could be a dramatic situation when implant removal will be requiested. (slide show the PFN d