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PFNA治疗股骨粗隆骨折fna粗隆间骨折治疗1Background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,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗2Background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.Harcour

t: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,Guangdong

AcademyofMedicalSciencesfna粗隆间骨折治疗3Classification31-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AODepartment

ofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗4A1A2A331-ADepartmentofOrthopedics,

GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesClassification----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fna粗隆间骨折治疗5Classification----AODepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAc

ademyofMedicalSciencesA1A2A3fna粗隆间骨折治疗631–A2/331–A1稳定的骨折不稳定的骨折fna粗隆间骨折治疗7Background手术治疗保守治疗——牵引保守治疗——防旋鞋Departmen

tofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗8⚫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fna粗隆间骨折治疗94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,Guangd

ongGeneralHospital,GuangdongAcademyofMedicalSciences理想的内植物所需的条件fna粗隆间骨折治疗101854Langenbeck1878Trendelenbur

g1907Delbet1925Smith-Petersen1932Johannsen/Jerusalem1934Moore1937Thorton1940Küntscher:fem.necknail1942Brittain1950Lezius195

2Jewett1954Küntscher:Y-nail1955Pohl1955Pugh-Massie1955Ender1965AO:angledbladeplates1967Küntscher1967Simon-Weidner/Ender1967Zickel19

70Teubner:doubleTplate1980AO:DHS1988Kempf:Gamma-Nail1996Friedl:glidingnail1996AO:PFN股骨近端骨折内植物使用的历史DepartmentofOrthopedi

cs,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗11DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofM

edicalSciences髓内固定髓外固定⚫ProximalFemoralNail(PFN)⚫Gamma-Nail⚫IntramedullaryHipScrew⚫ACE-Nail⚫股骨髁角钢板⚫DHS,CHS,DCS股骨近端骨折内植物分类fna粗隆间骨折治疗1

2股骨近端骨折生物力学正常情况下DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗13ddm=Fxdm=Fxd股骨近端骨折生物力学Department

ofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗141.DHS是最具代表性的髓外钉板系统2.适合于大多数股骨粗隆

间骨折3.静力加压与动力加压双重功能4.使骨折紧密结合，促进骨折愈合DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesDynamicHipScrew--DHSfna粗隆间骨

折治疗15DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesDynamicHipScrew--D

HSfna粗隆间骨折治疗16DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesDynamicHipScrew--DHSfn

a粗隆间骨折治疗17股骨颈长度变短，肢体短缩1粉碎性不稳定骨折，后内侧骨质缺损2骨折线位于DHS进针处时也不适用3DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalScience

sDHS手术存在的问题fna粗隆间骨折治疗18DHS失败病例DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedi

calSciencesfna粗隆间骨折治疗19DHS失败病例DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗

隆间骨折治疗20DHS失败病例DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗2131—A1：DHS31—A2：PFN31—A3：PFNDepartm

entofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciences1.BoldinC,etal.Theproximalfemoralnail(PFN)-aminimalinvasi

vetreatmentofunstableproximalfemoralfractures:aprospectivestudyof55patientswithafollow-upof15months.ActaOrthopScand

,2003,74:53-58.2.FlahiffCM,etal.Abiomechanicalevaluationofanintramedullaryfixationdeviceforintertrochantericfractures.JTrauma,1993,35:23-2

7.3.SadowskiC,etal.Treatmentofreverseobliqueandtransverseintertrochantericfractureswithuseofanintramedullarynailor95°screw-plate.JBoneJoi

ntSurg(Br),2002,84:372-381.4.张经纬,等.股骨转子间骨折不同手术方法比较.中华骨科杂志,2005,25:7-11.5.卢华定,等.股骨近端髓内钉在股骨转子周围骨折中的应用.中国骨与关节损伤杂志

,2005,20(4):246-248.6.姜磊,等.闭合复位PFN治疗高龄股骨粗隆间骨折的体会.中国骨与关节损伤杂志,2006,21(1):59-60.7.祝敬华,等.DHS与PFN在股骨粗隆间骨折中

的应用.中国骨与关节损伤杂志,2006,21:63-64.8.范忠明,等.PFNA治疗老年股骨粗隆间骨折.中国骨与关节损伤杂志,2009,24(2):151-153.9.周建华,等.PFNA治疗老年不稳定性股骨转子间骨折.中国骨与关节损伤杂志,2008,23(12):10

15-1017.fna粗隆间骨折治疗221.一个部件即完成了抗旋转及成角稳定性2.末端宽大的刀面尽可能多的压缩周围骨质，尤其是在骨质疏松的情况下，具有更好的抓持力3.PFNA螺旋刀片和骨质贴合紧密，增强了稳

定性，防止旋转和内翻畸形4.生物力学试验证明:螺旋刀片显著提高抗切出能力PFNA螺旋刀片DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMed

icalSciencesPFN-AvsPFNfna粗隆间骨折治疗23C—Arm必不可少DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨

折治疗24骨科牵引床DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗25骨科牵引床123骨折基本或部分

闭合复位向健侧倾斜，掌握前倾角内收、内旋患肢，纠正畸形DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedica

lSciencesfna粗隆间骨折治疗26DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesIntraope

rativefna粗隆间骨折治疗2752岁，男性12monthsDepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesCase1fna粗隆间骨折治疗28邓X

，Female，81YDepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesCase2fna粗隆间骨折治疗29丁XX，Male，74YDepartmentofOrthopedi

cs,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesCase3fna粗隆间骨折治疗30DepartmentofOrthopedics,GuangdongGeneralHospital,Guangdong

AcademyofMedicalSciencesMale，74YCase5fna粗隆间骨折治疗31DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSc

iencesMale，81YCase8fna粗隆间骨折治疗32DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesMale，70YCase9fna粗隆间骨折治疗

33Discussion生物力学：髓内系统固定强度明显优于DHS[1]术后可以早期下床活动粗隆部粉碎性骨折，进针部骨质粉碎也适用[2]PFNAReference:1.FlahiffCM,NelsonCL,GruenwaldJM,etal.Abiomechanicalevalua

tionofanintramedullaryfixationdeviceforintertrochantericfractures.JTrauma,1993,35:23-27.2.祝敬华,吴柏林,聂海洋.DHS与PFN在股骨粗隆间骨折中的应用.中国骨与关节损伤杂志,2006

,21:63-64.DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesfna粗隆间骨折治疗34术中应注意正确的颈干角、前倾角1螺钉退出、切割股骨头2髋内翻畸形——

进钉点的选择3DepartmentofOrthopedics,GuangdongGeneralHospital,GuangdongAcademyofMedicalSciencesPFNA手术存在的问题fna粗隆间骨折治疗35fna粗隆间骨折治疗36