秦月鹏 宋莹 侯洪涛

    [摘要] 股骨颈骨折是临床常见的骨折类型，根据骨折线与髂前上棘连线所成的夹角大小可分为3型，其中Pauwels Ⅲ型股骨颈骨折的力学特点特殊，其承受了巨大的剪切应力，术后各种并发症的发生率较高，是难治类型的股骨颈骨折。临床上治疗Pauwels Ⅲ型股骨颈骨折的常用手术方法主要分为四大类型：空心钉类、钉板系统类、骨瓣移植术和关节置换术。每种方法均各有优缺点，其中空心钉内固定术是治疗股骨颈骨折的常用方法，但其稳定性不如钉板系统;钉板系统可以取得坚强固定，但创伤相对较大;骨瓣移植术减少了术后两大并发症的发生率，但操作难度大、技术要求高;关节置换术适用于高龄患者，从根本上杜绝了股骨颈骨折的一些并发症，但却带来了关节置换的并发症。

    [关键词] 股骨颈骨折;Pauwels Ⅲ型;手术方法;优缺点

    [中图分类号] R687.3? ? ? ? ? [文献标识码] A? ? ? ? ? [文章编号] 1673-7210(2019)02(c)-0032-04

    [Abstract] Femoral neck fracture is a common type of fracture in clinic. According to the angle between the fracture line and the anterior superior iliac spine， it can be divided into three types. Among them， Pauwels type Ⅲ femoral neck fracture has special mechanical characteristics and bears huge shear stress. The incidence of various complications after operation is high， and it is a refractory type of femoral neck fracture. The commonly used surgical methods for Pauwels type Ⅲ femoral neck fracture are mainly divided into four types： hollow nails， nail plate system， bone flap transplantation and joint replacement. Each method has its own advantages and disadvantages ......