Li Jiantao, Zhang Licheng, Tang Peifu
Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China.
Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Jan 15;33(1):1-7. doi: 10.7507/1002-1892.201809076.
To summarize the evolving concept in treatment of intertrochanteric fractures and the development of internal fixation devices.
Related literature concerning the implant devices to treat intertrochanteric fractures was reviewed and analyzed in terms of the biomechanical characteristics, clinical application, and complications.
The treatment of intertrochanteric 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.
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.
总结股骨转子间骨折治疗理念的演变及内固定器械的发展。
回顾并分析有关治疗股骨转子间骨折的植入器械的相关文献，内容涉及生物力学特性、临床应用及并发症。
股骨转子间骨折的治疗理念已从保守治疗发展至手术治疗。手术策略包括髓外固定和髓内固定。由于具有微创及生物力学优势，髓内固定已逐渐成为股骨转子间骨折的主要治疗方式。然而，目前的髓内固定系统仍无法重建股骨近端的内侧皮质支撑，这导致在治疗不稳定骨折时出现一些失败案例。
股骨转子间骨折内固定的发展基于临床实践中对股骨转子间骨折的深入理解及生物力学理论。未来，内固定器械的更新设计将取决于重建内侧支撑及股骨转子间骨折二期稳定的治疗原则，最终实现提高股骨转子间骨折成功率及减少术后并发症的目的。
