股骨粗隆下区骨折是髋关节周围骨折中最难处理的一种骨折类型,多由高能量创伤所致的粉碎性骨折.非手术治疗有较高的畸形愈合、不愈合以及其他并发症发生率,因而,粗隆下骨折多主张手术治疗.Russell-Taylor分类方法临床较常用,有利于指导内固定方法的选择.对于小粗隆以下平面的骨折,采用标准的交锁髓内钉较理想.骨折波及到小粗隆但梨状窝未累及时,选用头髓钉或95°角钢板可取得满意效果.对于大粗隆骨折并累及梨状窝时,采用滑行打器械固定较好.DHS器械不适宜用于粗隆下骨折的治疗.%Fracture of the subtrochanteric area of the femur is one of the most difficult about the hip to manage. Many of these fractures are comminuted and result from high-energy trauma. Nonoperative treatment of these fractures may result in a significant rate of malunion,nonunion and other complications. Therefore,subtrochanteric fractures is preferred to be treated with operative methods. The Russell-Taylor classification is useful in planning the type of internal fixation. For fractures located below the level of the lesser trochanter, standard locked intramedullary nails can be used effectively. For fractures that extend into the lesser trochanter but do not involve the piriformis fossa, the options of a cephalomedullary nail versus a 95 degree fixed angle device have yielded the best results. For fractures that have proximal trochanteric extension into the area of the piriformis fossa,sliding nail screw devices may have some usefulness. The DHS implant is not employed for the treatment of subtrochanteric femoral fractures.
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