外展外旋法复位PauwelsⅢ型股骨颈骨折  

Closed reduction of Pauwels typeⅢfemoral neck fractures using the abduction-external rotation method

作　　者：孙国海 张武鹏 杨永良 庞洪前 王伯珉 Sun Guohai;Zhang Wupeng;Yang Yongliang;Pang Hongqian;Wang Bomin(Department of Trauma and Emergency,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东第一医科大学附属省立医院创伤急诊外科,济南250021

出　　处：《创伤外科杂志》2025年第4期260-264,共5页Journal of Traumatic Surgery

基　　金：山东省自然科学基金面上项目(ZR2021MH301)。

摘　　要：目的 探讨通过“外展外旋”来对股骨颈骨折进行复位的方法以应对难复性PauwelsⅢ型股骨颈骨折,为此类损伤的治疗提供一种有效的解决方案,从而降低切开复位的必要性。方法 回顾性分析2021年12月—2023年12月山东第一医科大学附属省立医院创伤急诊外科收治的20例难复性PauwelsⅢ型股骨颈骨折患者。其中男性16例,女性4例;年龄28~61岁,平均43.1岁。患者均为单侧骨折,其中左侧12例,右侧8例。致伤原因:道路交通伤6例,高处坠落伤2例,意外摔伤12例。在常规内收内旋牵引难以达到满意复位时,采用外展外旋的方法进行复位。复位满意后,患者均在术中X线透视下采用3枚空心螺钉或股骨颈动力交叉钉系统(FNS)对股骨颈骨折进行固定。记录患者手术时间、术中出血量、住院时间、术后并发症情况以及Harris髋关节功能评分。结果 患者术中通过外展外旋的复位方法进行调整复位后,股骨颈骨折均达到解剖复位,手术时间45~70 min,平均59.5 min;术中出血量10~50 m L,平均24.5 m L;患者住院时间为3~7 d,平均5.3 d;术后随访10~19个月,平均13.2个月。患者术后切口均愈合良好,无感染、骨折再移位、断钉、术后深静脉血栓形成等并发症发生。Harris评分结果显示优8例,良2例。结论 对于难复性PauwelsⅢ型股骨颈骨折,外展外旋法复位成功率高并极大避免了切开复位,缩短手术时间,是有效治疗方案。Objective To explore a novel reduction method for irreducible Pauwels typeⅢfemoral neck fractures,aiming to provide an effective treatment approach and reduce the necessity of open reduction.Methods A retrospective analysis was conducted on 20 cases with irreducible Pauwels typeⅢfemoral neck fractures admitted to our department from Dec.2021 to Dec.2023.This cohort consisted of 16 male and 4 female patients,aged 28-61 years,with an average of 43.1 years.All fractures were unilateral,with 12 on the left side and 8 on the right.The injury mechanisms included 6 cases of road traffic accidents,2 falls from height,and 12 accidental falls.When satisfactory reduction failed to be achieved with conventional adduction and internal rotation traction,the abduction-external rotation method was used for reduction.After then,all fractures were fixed with three cannulated screws or the femoral neck system(FNS)under intraoperative fluoroscopy.The intraoperative parameters and outcomes were recorded.Results Using the abduction-external rotation reduction method,anatomical reduction was achieved for all the 20 cases.The average surgical time was 59.5 min,range 45-70 min;intraoperative blood loss was 24.5 mL,range 10-50 mL;the hospital stay was 5.3 d,range 3-7 d.Patients were followed up for 10-19 months,13.2 months on average.All incisions healed well without infection,and there were no complications such as fracture displacement,broken screws,or postoperative deep vein thrombosis.Conclusion The abduction-external rotation reduction method for Pauwels typeⅢfemoral neck fractures has a high success rate,which significantly avoids the risk of open reduction,shortens the operation time,and is an effective treatment option for those hard-to-be-reduced by conventional ways.

关 键 词：股骨颈骨折 PauwelsⅢ型 外展外旋法 解剖复位 

分 类 号：R683.42[医药卫生—骨科学]