股骨粗隆间骨折治疗理念与内固定器械的发展概述  

Evolving concept in treatment of intertrochanteric fractures and development of internal fixation devices

作　　者：李建涛[1] 张里程[1] 唐佩福[1] LI Jiantao;ZHANG Licheng;TANG Peifu(Department of Orthopaedics,Chinese PLA General Hospital Beijing,100853,P.R.China)

机构地区：[1]中国人民解放军总医院骨科,北京100853

出　　处：《中国修复重建外科杂志》2019年第1期1-7,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：首都卫生发展科研专项项目(2016-1-5012)~~

摘　　要：目的总结股骨粗隆间骨折治疗理念的变化与内固定器械的发展历程。方法查阅国内外相关文献,以时间轴的顺序从股骨粗隆间骨折的治疗理念、临床应用及并发症等方面进行总结分析。结果股骨粗隆间骨折的治疗方式经历了保守治疗到手术治疗的转变,手术治疗分为髓外固定和髓内固定两种方式,髓内固定因微创和生物力学的优势而逐渐成为主要治疗方式。但目前的髓内固定系统仍不能实现重建股骨近端内侧皮质支撑,所以在不稳定型骨折治疗方面仍有失败风险。结论股骨粗隆间骨折内固定的变革与发展,是临床对股骨粗隆间骨折认识不断深入以及生物力学理论不断深化的结果。内固定器械将依据完善股骨粗隆间骨折内侧支撑和二次稳定的治疗原则更新迭代,最终实现提高骨折治疗成功率和降低术后并发症的目的。Objective To summarize the evolving concept in treatment of intertrochanteric fractures and the development of internal fixation devices.Methods Related literature concerning the implant devices to treat intertrochanteric fractures was reviewed and analyzed in terms of the biomechanical characteristics,clinical application, and complications.Results The treatment ofintertrochanteric fractures has undergone an evolving concept from conservative treatment to surgical treatment.Surgery strategies include extramedullary fixation and intramedullary fixation.Intramedullary fixation has gradually become the main treatment of intertrochanteric fractures due to its minimally invasive and biomechanical advantages.However,the current intramedullary fixation system still can not reconstruct the medial cortical support of the proximal femur,which leads to some failures in the treatment of unstable fractures.Conclusion The development of internal fixation of intertrochanteric fractures is based on the deep understanding and biomechanical theory of intertrochanteric fractures in clinical practice.In the future,the updated design of internal fixation devices will depend on the treatment principle of reconstruction of medial support and secondary stabilization of intertrochanteric fractures,and finally the purpose of improving success rate and reducing postoperative complications of intertrochanteric fracture will achieved.

关 键 词：股骨粗隆间骨折 内固定器械 治疗理念 

分 类 号：R683.42[医药卫生—骨科学]