临床上，如何评估并选择一个合适的骨折分型系统，我们认为应遵循以下二个原则：第一，该骨折分型能够充分评估骨折的预后；第二，根据骨折分型能够指导术前计划，选择最佳的手术方案。Seinsheimer分型由于认识到了股骨内侧皮质在骨折治疗中的作用，因此对于牵引或采用钢板技术治疗股骨转子下骨折具有指导意义，但是由于它忽略了髓内钉的治疗作用，因此它已不适应于髓内钉治疗骨折的分型需要。实际上由于髓内钉的良好生物力学特点，它在治疗股骨转子下骨折中已经取得了极佳的临床效果［12～18］。Kyle分型是根据治疗方法进行分型，由于它重视了髓内钉的固定技术，指导术前对于不同类型髓内钉的选择，因此是手术治疗股骨转子下骨折的最佳分型方法。
作者单位：肖湘 张铁良(天津医院创伤骨科，天津 300211)
朱光宇(中国中医研究院望京医院骨科，北京 100700)
参考文献
〔1〕Fielding JW, Magliato HJ. Subtrochanteric fractures. Surg Gynec Obstet, 1966, 122:555
〔2〕Kinast C, Bolhofner BR, Mast JW,et al. Subtrochanteric fractures of the femur. Clin Orthop, 1989,238:122
〔3〕Wiss DA, Matta JM,Sima W,et al. Subtrochanteric fractures of the femur. Orthopedics,1985, 8:797
〔4〕Zain Elabdien BS, Olerud S, Karlstrom G. Subtrochanteric fractures classification and results of ender nailing. Arch Orthop Trauma Surg, 1984, 103:241
〔5〕Trafton PG. Subtrochanteric-intertrochanteric femoral fractures. Orthop Clin Nor Am, 1987,18:59
〔6〕Fielding JW. Subtrochanteric fractures. Clin Orthop, 1973,192:86
〔7〕Wile PB, Panjabi MM, Southwick WO. Treatment of subtrochanteric fractures with a high-angle compression hip screw. Clin Orthop, 1983,175:72
〔8〕Donald AW. Subtrochanteric femur fractures. Operative Orthopedics Second Edition, edited by Michael W Chapman, JB Lippincott Company Philadelphia, 1993.605-620
〔9〕Watson HK, Campbell RD, Wade PA. Classification treatment and complications of the adult subtrochanteric fracture. J Trauma , 1964, 4:457
〔10〕Zickel RE.An intramedullary fixation device for the proximal part of the femur, nine year's experience. J Bone Joint Surg(Am),1976,58:866
〔11〕Seinsheimer FIII. Subtrochanteric fractures of the femur. J Bone Joint Surg(Am), 1978, 60:300
〔12〕Kyle RF.Fractures of the proximal part of the femur. J Bone Joint Surg(Am), 1994,76:924
〔13〕Smith JT,Goodman SB, Tischenko G. Treatment of comminuted femoral subtrochanteric fractures using the Russell-Taylor reconstruction intramedullary nail.Orthopedics, 1991,14:125
〔14〕Bose WJ,Corces A,Anderson LD. A preliminary experience with the Russell-Taylor reconstruction nail for complex femoral fractures.J Trauma, 1992,32:71
〔15〕Van Doorn R, Van der Hulst RR,et al. Van den Wildenberg intra-medullary fixation in (impending) femur fractures caused by tumor metastases. Ned Ti Jdschr Geneeskd, 1994, 138:2101
〔16〕Barlow IW, Thomas NP. Reconstruction nailing for subtrochanteric fractures in the pagetic femur.Injury, 1994, 25:426
〔17〕Merenyi G, Kovacs A,Zagh I.Preliminary experience with Gamma nails.Magy Traumatol Ortop Kezseb Plasztikai, 1994,37:319
〔18〕Stapert JW,Geesing CL, Jacobs PB, et al. First experience and complications with the long Gamma nail.J Trauma, 1993, 34:394
