手术-股骨颈骨折闭合复位内固定术.docxVIP

1、固定原则Please note that B1.1 and B1.2 fractures are impacted and stable. Type B1.3, however, is an undisplaced neck fracture which corresponds to Garden II and is potentially unstable.B1 fractures are best fixed with screws rather than the bulky sliding hip screw (DHS), which is an alternative.No reduction is necessary.?AO B1.1和B1.2骨折是嵌插和稳定的，B1.3骨折，是未移位股骨颈骨折与Garden Ⅱ型一致，是潜在的不稳定的。B1型骨折用螺钉固定优于DHS固定，但可选择替换。无须复位。2、松质骨螺钉固定Use two or three 7.0 mm or 7.3 mm cancellous screws. Make sure they are parallel and that the thread is in the head fragment and does not cross the fracture line.The inferior screw(s) should rest on the calcar. Washers should be used to stop the heads from penetrating the bone of the greater trochanter.These screws can be inserted open or percutaneously.使用2-3没7.0或7.3mm松质骨螺钉，确保其平行打入，并且螺纹部位要超过骨折线。下方的螺钉最好经过股骨距，钉尾加味垫圈可以防止钉帽传入大转子。可以切开复位固定也可闭合复位固定。3、体位The patient is positioned supine on a conventional operating table, or on a fracture table. C-arm image intensifier control during surgery is a must.Be gentle in transferring the patient and do not apply traction in order not to disimpact and displace the fragments.?病人仰卧牵引床上，必须在手术中可以使用术中CB。转运病人要轻柔，不要使用牵引，以免骨折移位。4、插入控制导针To ensure that the fixation screws come to lie parallel to the neck axis, insert the first guide wire by hand along the anterior surface of the neck and gently impact its tip into the head. Check its position using image intensification.确保固定螺钉与股骨颈轴线平行，在股骨颈前表面手动插入一枚克氏针直至股骨头。在CB监视下确定位置。?5、使用导向器If you are going to use an aiming device, expose the greater trochanter through a 10 cm incision.?如果准备使用导向器，则需要暴露约10cm切口。6、初步固定Place the aiming device onto the bone. The second guide wire is drilled through the central hole of the aiming device, parallel to the initial guide wire indicating the anteversion.This wire preliminarily fixes the fracture and defines the direction, in which the three guide wires for the cannulated screws will be introduced.Check the position of the second guide wire in both planes usi