股骨粗隆间骨折

股骨粗隆间骨折北京积水潭医院创伤骨科分型•Evans'classification(1949)•BoydandGriffin'sclassification(1949)•Ramadier'sclassification(1956)•Decoulx&Lavarde'sclassification(1969)•Ender'sclassification(1970)•Tronzo'sclassification(1973)•Jensen'sclassification(1975)•Deburge'sclassification(1976)•Briot'sclassification(1980)•AOclassification(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;DecoulxandLavarde).•提示预后(Tronzo;Ender;Jensen'smodificationoftheEvansgrading;Mülleretal.).Evans'classificationEvans'classification•TypeI:Undisplaced2-fragmentfracture•TypeII:Displaced2-fragmentfracture•TypeIII:3-fragmentfracturewithoutposterolateralsupport,owingtodisplacementofgreatertrochanterfragment•TypeIV:3-fragmentfracturewithoutmedialsupport,owingtodisplacedlessertrochanterorfemoralarchfragment•TypeV:4-fragmentfracturewithoutposterolateralandmedialsupport(combinationofTypeIIIandTypeIV)•R:Reversedobliquityfracture•AOclassificationAOclassification•A1:Simple(2-fragment)pertrochantericareafractures•A1.1Fracturesalongtheintertrochantericline•A1.2Fracturesthroughthegreatertrochanter•A1.3Fracturesbelowthelessertrochanter•A2:Multifragmentarypertrochantericfractures•A2.1Withoneintermediatefragment(lessertrochanterdetachment)•A2.2With2intermediatefragments•A2.3Withmorethan2intermediatefragments•A3:Intertrochantericfractures•A3.1Simple,oblique•A3.2Simple,transverse•A3.3Withamedialfragment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？DHSGAMMANAIL•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-ApexDistanceM.R.Baumgaertner,S.L.Curtin,D.1995.TADCUTOUTCUTOUT内固定失用（不愈合）畸形愈合股骨头缺血坏死VicarioC,MarcoF,OrtegaL,AlcobendasM,DominguezI,Lopez-DuranL.Injury.2003Feb;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Tronzo'sclassification(1973)内固定物选择M71ys谢谢！