《股骨粗隆间骨折_》-精选·课件.ppt

股骨粗隆间骨折 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) 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; Müller et al.). 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 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 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 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 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 TADTip-Apex Distance TAD 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？ 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？ 双钉？ 内固定物选择 内固定物选择 内固定物选择 后外侧壁 内固定物选择 * 北京积水潭医院创伤骨科 AO classification