Classification, Clinical Diagnosis and Treatment of Intertrochanteric Fractures of the Femur

Ward's Triangle

Ib cheeb tsam ntawm daim duab peb sab yog tsim nyob rau hauv lub hauv paus cheeb tsam uas femoral caj dab trabeculae hla. Hauv cov neeg laus uas muaj kab mob osteoporosis, thaj chaw no tsuas yog muaj roj.

Femoral Calcar

A dense bone plate located posterior - medial to the junction of the femoral neck and shaft deep to the lesser trochanter. Nws yog ib qho kev ncua ntawm lub posterior - medial cortex ntawm lub femoral ncej mus rau hauv cov pob txha tshem tawm thiab yog lub ntsiab lus ntawm daim ntawv thov ntawm eccentric load ntawm proximal femur.

Qib ntawm Hip Bone Trabeculae

 Kev muab qhab nia ntawm cov neeg kho tshuab lub zog ntawm proximal femur:
(1) Qib 6; (2) Qib 5; (3) Qib 4; (4) Qib 3; (5) Qib 2; (6) Qib 1

Kev mob hnyav heev hauv Cov Neeg Mob Hluas

Intertrochanteric fractures nyob rau hauv cov neeg mob hluas feem ntau yog tshwm sim los ntawm siab - lub zog raug mob xws li ntog los ntawm qhov siab thiab tsheb sib tsoo. Cov xwm txheej no tuaj yeem ua rau cov pob txha loj heev, thiab cov neeg mob yuav tsum tau saib xyuas kom zoo rau kev raug mob, nrog rau lub taub hau, txha nraub qaum, thiab lub plab thiab lub plab.

Yam Tseem Ceeb ntawm Kev Poob Hauv Cov Neeg Laus

90% ntawm intertrochanteric fractures nyob rau hauv cov neeg laus yog tshwm sim los ntawm ntog. Cov yam ntxwv uas ua rau cov neeg laus poob qis muaj xws li qhov muag tsis pom kev, txo cov leeg lub zog, cov ntshav tsis ruaj khov, tsis muaj peev xwm tiv thaiv, kab mob vascular, thiab kab mob hauv pob txha thiab pob qij txha.
   Txawm hais tias lub caij nplooj zeeg ua rau pob txha raug txiav txim siab los ntawm tsib yam hauv qab no: qhov hnyav ntawm pob txha pob txha, kev taw qhia ntawm lub caij nplooj zeeg, tshwj xeeb tshaj yog thaum lub duav lossis qhov chaw ze ntawm lub duav tsoo hauv av, qhov tsis txaus ntawm kev tiv thaiv reflexes kom txo tau lub zog ntawm lub caij nplooj zeeg, tsis muaj peev xwm ntawm lub duav mos cov ntaub so ntswg kom nqus tau lub zog txaus, thiab cov pob txha tsis muaj zog.

Hom Kev Ua Phem Txhaum Cai thiab Mechanisms of Action

1. Direct Violence: Kev raug mob siab-zog ua ncaj qha rau ntawm lub duav, xws li tsheb sib tsoo lossis ntog qhov twg lub duav raug cuam tshuam ncaj qha, ua rau tawg.

2. Indirect Violence: Lub cev torsion kawm lub duav mus rau varus thiab forward angulation stress. Nrog rau qhov tsawg dua trochanter raws li lub fulcrum, nws muaj zog compressed, thiab kuj tseem muaj cov nyhuv rub ntawm cov leeg iliopsoas, tsim ib tus npauj npaim - zoo li cov pob txha tawg. Qhov loj dua trochanter kuj tseem tuaj yeem tsim cov pob txha sib cais vim qhov muaj zog rub ntawm cov leeg gluteus medius.

Evans Classification

 Feem ntau siv rau hauv kev kho mob. Evans faib cov pob txha intertrochanteric ua ob hom:

1. Hom I: Trans - trochanteric fractures    Raws li kev ruaj ntseg ua ntej thiab tom qab txo qis, nws tau muab faib ua 4 subtypes:

• Ⅰa: Ob - ib feem tawg tsis muaj kev txav chaw.

• Ⅰb: Ob feem - pob txha tawg nrog kev hloov pauv, qhov nruab nrab cortex yog qhov tsis zoo, thiab cov pob txha puas ruaj khov tom qab txo qis.

• Ⅰc: Qhov tsawg dua trochanter yog dawb, nrog tawg tawg thiab varus deformity; los yog qhov loj dua trochanter yog cov pob txha cais.

• Ⅰd: Ntxiv nrog rau cov pob txha intertrochanteric, ob qho tib si ntau dua thiab tsawg dua trochanters ua cov pob txha tawg, nrog varus deformity.

• Ntawm lawv, hom Ⅰa thiab Ⅰb yog hom ruaj khov, thiab lwm yam yog hom tsis ruaj khov.

2. Hom II: Rov qab - oblique intertrochanteric fractures
   Hom II yog qhov thim rov qab - trochanteric pob txha, nrog cov kab tawg txuas ntxiv obliquely los ntawm qis dua qhov loj dua trochanter mus rau sab sauv ntawm qhov tsawg dua trochanter.

AO Classification

Hom A1: Ib qho yooj yim ob - qhov tawg ntawm lub trochanter, nrog kev txhawb nqa zoo ntawm cov pob txha cortex thiab cov pob txha sab nraud.

1. Raws li txoj kab intertrochanteric.

2. Los ntawm qhov loj dua trochanter.

3. Los ntawm qhov tsawg dua trochanter.

Hom A2: comminuted fractures los ntawm lub trochanter, nrog fractures ntawm nruab nrab cortex nyob rau hauv ob lub dav hlau, tab sis lub lateral pob txha cortex tseem nyob twj ywm.

1. Nrog ib tug medial fracture fragment.

2. Nrog rau ntau qhov nruab nrab ntawm cov pob txha tawg.

3. Nthuav ntau tshaj 1 cm hauv qab qhov tsawg dua trochanter.

Hom A3:  Rov qab - intertrochanteric fractures, nrog cov pob txha ntawm lub lateral cortex thiab.

1. Oblique.

2. Hloov.

3. Hais lus.

Feem ntau, hom A1.1 txog A2.1 raug suav hais tias ruaj khov, thiab hom A2.2 txog A3.3 suav tias tsis ruaj khov.

PFNA rau Kev Kho Mob ntawm Intertrochanteric Fractures ntawm Femur

PFNA yog siv rau qhov tsis ruaj khov osteoporotic intertrochanteric fractures xws li Evans Ic, Id, thiab Hom II. Nws muaj kev ua tau zoo dua, muaj peev xwm los tiv thaiv kev sib hloov, lub sijhawm ua haujlwm luv luv, txo qis ntshav, muaj teeb meem tsawg dua, thiab qhov ua tau qis dua ntawm kev sib txuas ntawm cov ntsia hlau ntsia hlau txiav - tawm, qhia pom kev kho kom zoo.

INTERTAN rau Kev Kho Mob ntawm Intertrochanteric Fractures ntawm Femur

Nrog rau kev txhim kho cov cuab yeej kho mob niaj hnub no, INTERTAN yog ib hom tshiab ntawm cov ntsia hlau intramedullary tshwj xeeb tsim los rau kev kho mob ntawm cov pob txha ntawm cov pob txha ntawm lub femur. Tus ntoo khaub lig - ntu ntawm nws lub ntsiab ntsia hlau yog trapezoidal. Thaum siv ua ke nrog cov ntsia hlau sib txuas sib txuas, nws tuaj yeem tiv thaiv 'Z' nyhuv. Qhov sib ntxiv ntawm tus ntsia thawv thib ob protruding los ntawm lub taub hau femoral tsub kom lub anti-rotational nyhuv ntawm lag ntsia hlau. Cov ntsia thawv intramedullary no muaj ntau yam kev siv thiab tsim nyog rau cov neeg mob uas muaj pob txha loj.