创伤性股骨头骨折的诊断与治疗进展

doi:10.3877/cma.j.issn.1674-134X.2025.03.012

股骨头骨折是股骨近端严重且少见的损伤，常合并髋臼骨折、髋关节脱位，伤情复杂处治难度大，而且疗效不尽如人意，目前国内外的文献以小型研究和病例报告系列为主。近年来，由于机动车事故的发生数量的增加，以及现代车辆安全性能的提高致使多发创伤患者的存活率显著提高，导致股骨头骨折的发生率稳步上升，并且股骨头骨折通常是高能量的关节内损伤，故对骨外科医生提出了挑战。本文就近年来国内外对该骨折的损伤机制、分型、治疗进行叙述性回顾。

关键词: 股骨颈骨折, 分类法, 治疗

Femoral head fractures are serious and rare injuries of the proximal femur, often associated with acetabular fractures and hip dislocations, which are complex and difficult to treat with unsatisfactory results, and the current literature in the UK and abroad is dominated by small studies and case report series. In recent years, due to the increase in the number of motor vehicle accidents and the improved safety performance of modern vehicles, the survival rate of patients with multiple trauma has increased significantly, resulting in a steady increase in the incidence of femoral head fractures, which are usually high-energy intra-articular injuries and therefore pose a challenge to orthopaedic surgeons. This article presents a narrative review of the mechanism of injury, typing and treatment of this fracture in recent years, both nationally and internationally.

Key words: Femoral neck rractures, Classification, Therapy

图1 股骨头骨折的损伤机制。图A示强迫内收位置；图B示中性内收位置；图C示中间旋转位置

Figure 1 Injury mechanism of femoral head fractures. A is forced inward position; B is neutral inward position; C is intermediate rotation position

图2 股骨头骨折的Pipkin分型

Figure 2 Pipkin Classification of femoral head fractures

表1 髋关节脱位和股骨头骨折的Brumback分型

Table 1 Brumback classification of hip dislocation and femoral head fractures

分型	髋关节脱位	内容
Type ⅠA	髋关节后脱位	股骨头内下侧骨折（股骨头的非承重区）伴轻微或无髋臼骨折；髋关节稳定
Type ⅠB	髋关节后脱位	股骨头内下侧骨折（股骨头的非承重区）伴明显髋臼骨折；髋关节不稳定
Type ⅡA	髋关节后脱位	股骨头上内侧骨折（股骨头的承重区）伴轻微或无髋臼缘骨折；髋关节稳定
TypeⅡB	髋关节后脱位	股骨头上内侧骨折（股骨头的承重区）伴明显髋臼骨折；髋关节不稳定
Type ⅢA	髋关节脱位（无特定方向）	股骨颈骨折
Type ⅢB	髋关节脱位（无特定方向）	股骨颈骨折并伴有股骨头骨折
Type ⅣA	髋关节前脱位	股骨头骨折（凹陷型，股骨头外上方负重面压缩）
Type ⅣB	髋关节前脱位	股骨头骨折（经软骨型，股骨头负重面的骨软骨撕脱骨折）
Type Ⅴ	髋关节中心性脱位	股骨头骨折

表1 髋关节脱位和股骨头骨折的Brumback分型

Table 1 Brumback classification of hip dislocation and femoral head fractures

分型	髋关节脱位	内容
Type ⅠA	髋关节后脱位	股骨头内下侧骨折（股骨头的非承重区）伴轻微或无髋臼骨折；髋关节稳定
Type ⅠB	髋关节后脱位	股骨头内下侧骨折（股骨头的非承重区）伴明显髋臼骨折；髋关节不稳定
Type ⅡA	髋关节后脱位	股骨头上内侧骨折（股骨头的承重区）伴轻微或无髋臼缘骨折；髋关节稳定
TypeⅡB	髋关节后脱位	股骨头上内侧骨折（股骨头的承重区）伴明显髋臼骨折；髋关节不稳定
Type ⅢA	髋关节脱位（无特定方向）	股骨颈骨折
Type ⅢB	髋关节脱位（无特定方向）	股骨颈骨折并伴有股骨头骨折
Type ⅣA	髋关节前脱位	股骨头骨折（凹陷型，股骨头外上方负重面压缩）
Type ⅣB	髋关节前脱位	股骨头骨折（经软骨型，股骨头负重面的骨软骨撕脱骨折）
Type Ⅴ	髋关节中心性脱位	股骨头骨折

图3 股骨头骨折的紧急救治流程

Figure 3 Emergency treatment protocol for femoral head fractures

图4 根据Pipkin分型的治疗方法

Figure 4 Treatment methods based on the Pipkin Classification

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Advances in diagnosis and treatment of traumatic femoral fractures

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Advances in diagnosis and treatment of traumatic femoral fractures