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1、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,GuangdongAcademyofMedicalSciencesBackground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
2、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,GuangdongAcademyofMedicalScien
3、cesClassification31-A32：股骨干31：股骨近端31：股骨远端31–B：关节囊内的股骨颈骨折31–A：关节囊外的转子间骨折31–A：关节囊内的股骨头骨折AODepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesA1A2A331-ADepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalScience
4、sClassification----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,GuangdongAcademyofMedicalSciencesA1A2A331–A2/331–A1稳定的骨折不稳定的骨折Background手术治疗保守治疗——牵引保守治疗——防旋鞋Departm
5、entofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences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,GuangdongAcademyofMedica
6、lSciences理想的内植物所需的条件1854Langenbeck1878Trendelenburg1907Delbet1925Smith-Petersen1932Johannsen/Jerusalem1934Moore1937Thorton1940Küntscher:fem.necknail1942Brittain1950Lezius1952Jewett1954Küntscher:Y-nail1955Pohl1955Pugh-Massie1955Ender1965AO:angledbladeplates1967K
7、üntscher1967Simon-Weidner/Ender1967Zickel1970Teubner:doubleTplate1980AO:DHS1988Kempf:Gamma-Nail1996Friedl:glidingnail1996AO:PFN股骨近端骨折内植物使用的历史DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesDepartmentofOrthopedics,GuangdongGener
8、alHospital,GuangdongAcademyofMedicalSciences髓内固定髓外固定ProximalFemoralNail(PFN)Gamma-NailIntramedullaryHipScrewACE-Nail股骨髁角钢板DHS,CHS,DCS股骨近端骨折内植物分类股骨近端骨折生物力学正常情况下DepartmentofOr
