股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)的心得體會(huì)作者:韓龍導(dǎo)師:張仲文術(shù)者:張仲文、張東正、侯建姚敏敏、叢波、韓龍北京武警總醫(yī)院骨四科醫(yī)生股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手1轉(zhuǎn)子間骨折Evans分型[型:單純轉(zhuǎn)子間骨折,無(wú)移位門:股骨距完整,有移位,小轉(zhuǎn)子撕脫骨折玒:股骨距受累,有移位,小轉(zhuǎn)子骨折Ⅳ型:大小轉(zhuǎn)子粉碎性骨折V型:反轉(zhuǎn)子間骨折轉(zhuǎn)子間骨折Evans分型2病人概況患者喻國(guó)明,男,高處摔傷致左側(cè)股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折。按股骨粗隆間骨折Evans分型,屬于大、小粗隆同時(shí)骨折的ⅣV病人概況3骨折三維CT圖像際普骨折三維CT圖像4左俯圖位體位的重要性一左俯圖位體位的重要性一5刎俯臥位體位的重要性患者右側(cè)患肢,取左側(cè)臥位根據(jù)骨折情況,便于骨折復(fù)位。手術(shù)入路的選擇決定次種體位。方便C型臂的拍攝刎俯臥位體位的重要性6消毒的載r消毒的載r7消毒的技巧為了保證消毒范圍,可用支腿架,繃帶將患肢提起至合適高度,充分暴露會(huì)陰,碘酊消毒下肢,碘伏消毒會(huì)陰。常規(guī)鋪巾消毒的技巧8手術(shù)視手術(shù)視9手術(shù)視野手術(shù)視野的選擇根據(jù)手術(shù)入路。手術(shù)入珞選擇:左側(cè)股骨外側(cè)入路改良(將股外側(cè)肌、股中間肌向前牽拉,并不從行切開)該入路有利于充分暴露股骨干的視野,便于延長(zhǎng)手術(shù)切口范圍。手術(shù)視野10股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件11股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件12股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件13股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件14股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件15股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件16股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件17股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件18股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件19股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件20股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件21股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件22股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件23股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件24股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件25股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件26股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件27股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件28股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件29股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件30股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件31股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件32股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件33股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件34股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件35股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件36股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件37股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件38股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件39股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件40股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件41股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件42股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件43股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件44股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件45股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件46股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件47股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件48股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件49股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件50股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件51股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件52股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件53股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件54股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件55股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件56股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件57股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件58股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件59股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件60股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件61股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件62股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件63股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件64股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)的心得體會(huì)作者:韓龍導(dǎo)師:張仲文術(shù)者:張仲文、張東正、侯建姚敏敏、叢波、韓龍北京武警總醫(yī)院骨四科醫(yī)生股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手65轉(zhuǎn)子間骨折Evans分型[型:單純轉(zhuǎn)子間骨折,無(wú)移位門:股骨距完整,有移位,小轉(zhuǎn)子撕脫骨折玒:股骨距受累,有移位,小轉(zhuǎn)子骨折Ⅳ型:大小轉(zhuǎn)子粉碎性骨折V型:反轉(zhuǎn)子間骨折轉(zhuǎn)子間骨折Evans分型66病人概況患者喻國(guó)明,男,高處摔傷致左側(cè)股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折。按股骨粗隆間骨折Evans分型,屬于大、小粗隆同時(shí)骨折的ⅣV病人概況67骨折三維CT圖像際普骨折三維CT圖像68左俯圖位體位的重要性一左俯圖位體位的重要性一69刎俯臥位體位的重要性患者右側(cè)患肢,取左側(cè)臥位根據(jù)骨折情況,便于骨折復(fù)位。手術(shù)入路的選擇決定次種體位。方便C型臂的拍攝刎俯臥位體位的重要性70消毒的載r消毒的載r71消毒的技巧為了保證消毒范圍,可用支腿架,繃帶將患肢提起至合適高度,充分暴露會(huì)陰,碘酊消毒下肢,碘伏消毒會(huì)陰。常規(guī)鋪巾消毒的技巧72手術(shù)視手術(shù)視73手術(shù)視野手術(shù)視野的選擇根據(jù)手術(shù)入路。手術(shù)入珞選擇:左側(cè)股骨外側(cè)入路改良(將股外側(cè)肌、股中間肌向前牽拉,并不從行切開)該入路有利于充分暴露股骨干的視野,便于延長(zhǎng)手術(shù)切口范圍。手術(shù)視野74股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件75股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件76股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件77股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件78股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件79股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件80股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件81股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件82股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件83股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件84股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件85股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件86股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件87股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件88股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件89股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件90股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件91股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件92股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件93股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件94股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件95股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件96股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件97股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件98股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件99股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件100股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件101股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件102股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件103股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件104股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件105股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件106股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件107股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件108股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件109股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件110股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件111股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件112股骨轉(zhuǎn)子間合并轉(zhuǎn)子下骨折手術(shù)課件113股骨轉(zhuǎn)子間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