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1、a,1,股骨转子下骨折,复旦大学附属华山医院骨科陈文钧,a,2,I型：骨折未累及梨状窝A：骨折未累及小转子B：骨折累及小转子II型：骨折延伸至梨状窝C：骨折未累及小转子D：骨折累及小转子,a,3,a,4,A3,a,5,近端：髂腰肌、外展外旋肌远端：内收肌,旋转加移位,a,6,a,7,属于不稳定骨折，髓内固定首选,a,8,风险：不稳定导致骨不愈合和失败率高,a,9,骨的质量骨折类型内植物的选择复位内植物放置,a,10,a,11,a,12,治疗选择：钢板的比较（LP应力分布更好）,a,13,a,14,a,15,骨不连的治疗：Diamond concept（坚强固定+BMP）,a,16,骨不连的治疗
2、：Diamond concept（坚强固定+BMP）,a,17,骨不连的治疗：Diamond concept（坚强固定+BMP）,a,18,失败,内固定质量患者骨量植入物选择不当复位欠佳固定技术不良理念混乱,a,19,Surgical implants are exposed to severe working conditions,including mechanical loading (cyclic and shock), chemicalaggression (body fluids) and the static or dynamic contactbetween the impla
3、nt materials or the state of implant-to-bonecontact .Therefore,a wide range of failure mechanisms may occur, including fatigue, corrosion, wear, fretting and combinations of them.The mechanical failures of metallic implants may also be influenced by several other factors, including the design, mater
4、ial selection, manufacturing practice, improper installation,postoperative complications and misuse .,Investigation of a fatigue failure in a stainless steel femoral plateJB. Marcomini a, n , C.A.R.P. Baptista a , J.P. Pascon a , R.L. Teixeira b , F.P. Reis,a,20,9-19 周贤云 男 40岁 B0065572入院时间： 2016-12-
5、15手术时间： 2016-12-19主诉：摔伤致右髋部疼痛，无法行走3小时体检：右侧髋部周围肿胀明显，压痛（+），下肢活动受限。左下肢感觉无异常，远端末梢循环正常，足背动脉搏动存在，足趾活动正常，余肢体无殊。诊断：右股骨粗隆下骨折 右股骨头坏死减压术后,a,21,a,22,a,23,2017-08-11,2017-02-07,a,24,9-10 孙正杰 男 65岁 B029811入院时间： 2014-09-26手术时间： 2014-09-29主诉：外伤致左髋关节疼痛伴活动障碍5天体检：脊柱生理弯曲存在，腰背部无压痛，脊柱生理弯曲存在，各棘旁无压痛。左髋肿胀，压痛（+)，感觉无异常，肌力0级，左
6、踝关节融合术后。诊断：左股骨近端骨折、脊髓灰质炎后遗症手术：左股骨切开复位内固定 (Smith Nephew: Peri-Loc钢板),a,25,a,26,2014-10-08,2015-05-12,2016-05-24,a,27,9-39 郎永梅 女 63岁 B0075344入院时间： 2017-5-19手术时间： 2017-5-22主诉：跌倒后左下肢疼痛伴活动障碍2小时。体检：左髋畸形，肿胀，股骨近端压痛，纵向叩击痛（+），活动受限，其余肢体及足趾感觉运动正常。末梢血运可。诊断：左股骨粗隆下骨折手术：左股骨粗隆下骨折切开复位内固定术,a,28,a,29,a,30,2017-06-01,a,31,2017-08-29,钢板使用是否合理植骨？再干预？时机？,a,32,男 41岁,2017-02-26,a,33,2017-03-08,2017-04-06,a,34,2017-05-10,2017-08-29,a,35,a,36,2010.10Male 39,术后一年,a,37,术后二年,a,38,男 27岁2017.03,a,39,a,40,单一植入物,植入物质量骨质量解剖复位,a,41,技巧,辅助钢板置于前外侧尝试侧卧位C臂45度放置-患肢45度外旋,a,42,总结,稳定稳定再稳定解剖复位（不被BO忽悠）合理使用双固定 拐杖作用 延长主植入物寿命,a,43,Thanks,
