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中文摘要：
目的：探讨矢状位不稳定的转子间骨折的形态特征和复位技术。方法：回顾性分析北京大学人民医院创伤骨科2009年3月至2016年6月,通过股骨近端防旋转髓内钉（proximal femoral nail anti-rotation,PFNA）内固定手术治疗的矢状位不稳定转子间骨折,获得完整随访36例,其中切开复位组17例,微创复位组19例,分析手术时间、术中出血量、术中透视时间、尖顶距、螺旋刀片滑动距离、骨折愈合时间和髋关节Harris评分等指标,以及骨折的影像学形态特征。结果：平均随访15个月,微创复位组在手术出血量方面明显少于切开复位组（P〈0.001）,而在其他评价指标等方面,两组之间差异无统计学意义。从骨折形态特征看,有分离移位的近端前向不稳定多于有嵌插的近端后向不稳定,且前者的突出特征是股骨近端前内侧面的长斜行骨折,其在远骨折端的对应区域形成V形缺损,在外旋位X线片上较明显。结论：矢状位不稳定骨折分为有嵌插的近端后向不稳定和有分离的近端前向不稳定两种类型,两种类型各有特征,手术应尽可能用微创技术进行复位。
英文摘要：
Objective：To investigate the morphology character of sagittally unstable intertrochanteric fractures and reduction methods.Methods： A retrospective study was used to analyze the clinical data of sagittally unstable intertrochanteric fractures cases,which were treated with proximal femoral nail anti-rotation （PFNA） fixation from March 2009 to June 2016.In the study,36 cases were followed up completely,in which 17 cases accepted open reduction,and the other 19 cases accepted minimally invasive reduction.The operation time,amount of bleeding,the fluoroscopy times,postoperative radiographic measurements,such as tip-apex distance （TAD） and sliding distance of the spiral screw,and hip Harris scores were analyzed.The morphology character of the fractures was documented and investigated.Results： The average follow-up time was 15 months.The amount of bleeding of the open reduction group was （170.5±19.7） mL,and the amount of bleeding of the minimally invasive group was （54.7±12.5） mL.The amount of bleeding of the minimally invasive group was significantly less than that of the open reduction group （P〈0.001）.Between the two groups,there were no significant differences in other evaluation parameter,including operation time （P=0.054）,the fluoroscopy times （P=0.053）,fracture healing time （P=0.305）,postoperative radiographic measurements,such as TAD （P=0.317） and sliding distance of the spiral screw （P=0.206）,and hip Harris scores （P=0.459）.In regard to morphology character of the fractures,the proximal anterior unstable fractures with separation displacement were more common than the proximal posterior unstable fractures with impaction.The characteristic feature of the proximal anterior unstable fractures was the proximal anterior and medial long oblique fracture,and a V shape cortical defect in the distal fracture fragment on the externally rotation X-ray.Conclusion： Sagittally unstable intertrochanteric fractures can be divided into the proximal anterior unstable fractu
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