转子间骨折内固定术后不稳定的力学分析及相关策略（附96例报告）

目的从力学分析的角度探讨股骨转子间骨折内固定术后不稳定的方式、原因及相关对策。方法对作内固定治疗的96例转子间骨折病例，术后及每6周随访摄片，作力学分析。结果18例术后发生改变，其中2例有明显的髋内翻（颈干角≤110°），2例有旋转内翻改变（颈干角〉110°），14例有股骨颈短缩现象。结论转子间骨折后内固定与骨折区域构建的力学缺陷是术后不稳的主要原因，大转子与小转子的稳定对维护骨折术后的稳定有重要作用，在可能的情况下都应该予以重建，但这不是起唯一决定作用的因素。目前的内固定系统，如果构建合理，在力学上能够替代因复杂骨折所致的力学不稳。因此，最重要的是充分分析和预见每一骨折类型可能出现的力学不稳定而进行合适的固定，制定合理的策略。

Ananlysis on post-Operative unstability of intertrochanter fracture of femur and the treatment(96cases report)

Objective To explore the reason of post - operative unstability of intertrochanter fracture of femur, as well as some tactics help. Methods We performed mechanical analysis on post - operative roentgenographs of 96 cases of intertrochanter fracture of femur treated by internal fixation in our hospital from Apr 2004 to Oct 2006. All cases were followed up and radiographed every 6 weeks till bone union. Result 18 cases changed in alignment post - operatively, 2 of these got coxa vara（ Collodiaphyseal angle≤110°）, another 2 cases got coxa vara （Collodiaphyseal angle 〉 110°） together with rotational unstable ,the other 14 cases had a lack in length of femoral neck. Conclusions The post - operative unstability of intertrochanter fracture of femur is mainly due to the mechanical defect in the area botween bone and internal fixation. Reduction and thus the stabihty of the greater and lesser trochanter play an important role. So we should try to reconstruct them though this is not the only key point. The internal fixation system can maintain stability only by properly mechanically applying.