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1、股骨颈骨折全英文教学版陈芒芒,1,Femoral Neck Fractures-a changing paradigm,Department of Orthopaedics-Mangmang Chen,股骨颈骨折全英文教学版陈芒芒,2,Definition1 one of the most commonly treated orthopaedic injuries,3.58%2 increasing number of femoral neck fractures.Longer lifespan of patientsIncreased activity of patientsOsteopor
2、osis3(这里可以放一些图片),股骨颈骨折全英文教学版陈芒芒,3,Demographics:Most 75y Over 1 million femoral neck fractures were treated in the 65 year old population in the US Between 1991-2008.(有一张图片最好，地图分布图),股骨颈骨折全英文教学版陈芒芒,4,Hip Fractures:DemographicsVery heterogeneous patient populationCan ranger from independent mobile,heal
3、thy elderly patientsVary degress of dementia(1分38的时候看不懂),股骨颈骨折全英文教学版陈芒芒,5,110140，average 127 。140 coxa valgus110 coxa vara,Anatomy,Collodiaphysial angle,Axis,股骨颈骨折全英文教学版陈芒芒,6,Anatomy,Collodiaphysial angle,Axis,Elderly people：indirect violencelow energy damageYoung adults： indirect violencehigh energ
4、y damagenonunion1020（ shear force greater ），AVN2040（Blood supply）,股骨颈骨折全英文教学版陈芒芒,7,femoral neckanteversion,The axis of the femoral neck and femoral coronary forming Angle,1215,Anatomy,股骨颈骨折全英文教学版陈芒芒,8, Small artery ：Femoral head round ligament ，1/20shaft of the femur;nutrient artery thearteryringon
5、thefundusofneckoffemur ： medial femoral circumflex artery; lateral femoral circumflex artery;The main source ， 2/3 4/5,Anatomy,Blood supply,股骨颈骨折全英文教学版陈芒芒,9,Blood supply,Anatomy,medial femoral circumflex artery-AVN the main factor,thearteryringon thefundusofneckoffemur,股骨颈骨折全英文教学版陈芒芒,10,According to
6、 the location,classification,fracture lines closer to the femoral headRich blood supplyPoor blood supply-rate of the necrosis,Fracture end;Contact area,股骨颈骨折全英文教学版陈芒芒,11,According to X-ray,Formed by fracture line and horizontal line(Iliac Creast)the greater the angle;compressive stress ; fracture en
7、d;contact area;unstable,classification,股骨颈骨折全英文教学版陈芒芒,12,Pauwels angle,abduction type： Pauwels angle50unstable,classification,股骨颈骨折全英文教学版陈芒芒,13,thedegreeofdisplacementoffracture,Type :incomplete fracture 5Type II：complete fracture,Not displaced 18Type III： complete fracture ，partially displaced 28Ty
8、pe IV： complete fracture ,completely displaced 38 -1994Generally,the greater the displacement,the greater risk of,Garden classification,股骨颈骨折全英文教学版陈芒芒,14,Clinical manifestation and diagnose,Medical history：history of trauma,Physical sign： 1.malformation： extorsion deformity-45 60。 2.pain：local tende
9、rness;the axial taps pain-positive。 3.limb shortening：the greater trochanter,shift up,股骨颈骨折全英文教学版陈芒芒,15,limb shortening,Bryant triangle ；bottom margin-shortenHorizontal position,The apex of the greater trochanter,above the Nelatons lineLateral position,股骨颈骨折全英文教学版陈芒芒,16,Imageological examination,X-r
10、ay：Pelvis AP，hip joint AP,L3-dimensional CTMRI：incipient fracture,股骨颈骨折全英文教学版陈芒芒,17,X-ray：hardened zone(bottom of the femoral neck)MRI：weaker signal,Femoral Neck Fracture,股骨颈骨折全英文教学版陈芒芒,18,Differential diagnosis,股骨颈骨折全英文教学版陈芒芒,19,Hip fractures management:Goals,1 restore function to preopertive state
11、(if possible)2 one operation for life3 lowest complication rate（放几张并发症的图片，举例）,股骨颈骨折全英文教学版陈芒芒,20,Hip fractures management:options,1 open reduction and internal fixation2 close reduction and internal fixation3hemiarthroplasty Unipolar Bipolar(可以放一些图片)4Total hip arthroplasty etc.,股骨颈骨折全英文教学版陈芒芒,21,Trea
12、tment,The therapeutic regime depend on 1.which part 2.the degree of displacement 3.age 4.etcOTHER:1what was their prior activity level2what co-morbidities do they have3will they be compliant with rehab protocol(such dislocation precautions),股骨颈骨折全英文教学版陈芒芒,22,Conservation treatment：not displaced ;imp
13、acted fracture;intolerance of operation,Traction/anti-rotation shoe：lie in bed 812w3m partial weight-bearing walking，6m total weight-bearing walking,股骨颈骨折全英文教学版陈芒芒,23,Conservation treatment,Reexamine the X-ray(bedside);IfoperationDeep venous thrombosisAttach importance to nursing work-prevention mea
14、sures:decubitus ulcer、hypostatic pneumonia、urinary tract infection,depressive disorder;ect(complication)。,股骨颈骨折全英文教学版陈芒芒,24,Operative treatment:displaced;unstable,IF：stable condition;no chronic disease;high functional requirements;bone quality;younger;minimally displaced fracturesTHA：65;chronic dise
15、ase;Osteoporosis;subcapital;poor patient compliance,股骨颈骨折全英文教学版陈芒芒,25,IF：,X-ray:close/open,reduction IF;percutanousX-ray:anatomical reductionBenefits of IF:Disadvantages:Whats the definite constraindications:Presence of arthritisDisplaced fracture in elderly people,1sliding internal fixation2compres
16、sive internal fixation,股骨颈骨折全英文教学版陈芒芒,26,1 flex joint 90，tract along the axis of the femur2 internal rotation,abduction3keep internal rotation,abduction，straight leg 4 adduction,keep internal rotation,How toReduct,股骨颈骨折全英文教学版陈芒芒,27,sliding internal fixation,Slidebear load-compression。Smith-Petersen
17、nailDestruct the blood supply aseptic necrosisNo compression ununion,股骨颈骨折全英文教学版陈芒芒,28,compressive internal fixation,Reliable fixation，slight injury to soft tissue，less damage to blood supply,股骨颈骨折全英文教学版陈芒芒,29,（DHS)dynamic hip screw,股骨颈骨折全英文教学版陈芒芒,30,compressive internal fixation,股骨颈骨折全英文教学版陈芒芒,31,c
18、ompressive internal fixation,股骨颈骨折全英文教学版陈芒芒,32,Bone graftingIF,free bone graftpedicle bone graft：Sartorius musculoskeletal flapquadratus femoris muscle pedicle bone graft,股骨颈骨折全英文教学版陈芒芒,33,Hip joint replacement,Subcapital in elderly people、old fracture、nonunion/AVN(avascular necrosis of femoral head
19、)Total hip arthroplastyHemiarthroplasty Unipolar BipolarHistorically,higher dislocation rateMore invasive,股骨颈骨折全英文教学版陈芒芒,34,Hemiarthroplasty,股骨颈骨折全英文教学版陈芒芒,35,Total hip arthroplasty,股骨颈骨折全英文教学版陈芒芒,36,Expectation,20-30% patient will die within 1 year of surgery3% in-hospital mortality rateUp to 30% require revision surgery,股骨颈骨折全英文教学版陈芒芒,37,Expectation,这里的原话，我觉得翻译下好。As the prolonged lifespanThe rate of fractureProblem:AVN,nonunion,BUT chance.Q1：?,股骨颈骨折全英文教学版陈芒芒,38,Thanks,Thanks,