亚洲髋演示-骨科手术器械课件.ppt

1、Hip Fracture Portfolio April 2009Hip fracture Market 中国每年约中国每年约1.5 million髋部骨折髋部骨折 50% 粗隆周围骨折粗隆周围骨折 50% 不稳定骨折不稳定骨折 50岁以上岁以上1年内死亡率年内死亡率25% 40%需要特殊护理需要特殊护理 50% 愈合后需要辅助行走愈合后需要辅助行走Hip fracture Legend1950198019902000Hip fracture Total SolutionIntegrated Interlocking ScrewsFemoral Head And Shaft Stability

2、Linear CompressionORS 2004Peri-Loc 4.5mm Proximal Femur Locking PlateDesign Features and BenefitsDesign Features and Benefits ContinuedDesign Features and Benefits ContinuedLateral Wall SupportPalm et al., “Integrity of the Lateral Femoral Wall in Intertrochanteric Hip Fractures: An Important Predic

3、tor of a Reoperation”, JBJS 2007; 89: 470475Gotfried, “The Lateral Trochanteric Wall: A Key Element in the Reconstruction of Unstable Pertrochanteric Hip Fractures”, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Number 425, pp. 8286InterTAN CHSDesign Features and BenefitsRotational StabilityThe unique

4、 figure-8 design of the integrated INTERTAN lag and compression screws optimizes femoral neck and head stability to significantly increase resistance to rotational instability and post-operative failure due to cut-out.PERI-LOC TechnologyPERI-LOC screw holes in the plate shaft combine the advantage o

5、f fixed-angle stability with the flexibility and benefits of traditional plate and screw technology. Screw holes accept 4.5mm Cortex and/or 4.5mm Locking Screws.Enhanced Lateral StabilityThe proximal flange of the INTERTAN CHS side-plate buttresses the greater trochanter and lateral cortex of the pr

6、oximal femur for increased resistance to medial fragment lateralization. Hot topic治疗要点（一）治疗要点（一） Use the Tip-to-Apex Distance -永远关注永远关注TAD 治疗要点（二）治疗要点（二） No Lateral Wall,no hip screw -外侧皮质不完整，不可用加压滑动螺钉外侧皮质不完整，不可用加压滑动螺钉 治疗要点（三）治疗要点（三）Know the Unstable Intertrochanteric Fracture Patterns, and Nail The

7、m -了解不稳定粗隆间骨折的类型，并用髓内钉固定了解不稳定粗隆间骨折的类型，并用髓内钉固定 Unloads the lateral cortex治疗要点（四）治疗要点（四）Beware of the Anterior Bow of the Femoral Shaft -注意股骨前弓注意股骨前弓 治疗要点（五）治疗要点（五）When Using a Trochanteric Entry Nail, Start Slightly Medial to the Exact Tip of the Greater Trochanter -大粗隆钉的进针点在顶点的偏内侧大粗隆钉的进针点在顶点的偏内侧 治疗要

8、点（六）治疗要点（六）Do Not Ream an Unreduced Fracture -骨折未复位前不要扩髓骨折未复位前不要扩髓 治疗要点（七）治疗要点（七） Be Cautious About the Nail Insertion Trajectory, and Do Not Use a Hammer to Seat the Nail -主钉插入时注意通道，不要用滑锤打入主钉插入时注意通道，不要用滑锤打入 1.选择正确进针点2.开口器足够深3.扩髓大于1mm治疗要点（八）治疗要点（八）Avoid Varus Angulation of the Proximal FragmentUse t

9、he Relationship Between the Tip of the Trochanter and the Center of the Femoral Head -用大粗隆顶点和股骨头中心之间位置关系来避免股骨近端骨块内翻成角用大粗隆顶点和股骨头中心之间位置关系来避免股骨近端骨块内翻成角 治疗要点（九）治疗要点（九）When Nailing, Lock the Nail Distally if the Fracture Is Axially or Rotationally Unstable -骨折有轴向或旋转不稳定，远端一定要锁骨折有轴向或旋转不稳定，远端一定要锁 如有必要选择长钉如有必要选择长钉 治疗要点（十）治疗要点（十）Avoid Fracture Distraction When Nailing -主钉插入时不要牵引主钉插入时不要牵引