目的：评估颈基底型股骨粗隆部骨折的特点和发生率，探究其诊断及治疗方式。方法： 选择北京大学第三医院骨科2005年1月至2016年5月收治的832例粗隆部骨折病例,其中28例（3.37%）为颈基底型骨折患者,对其进行回顾性分析，分别采用空心钉、动力髋螺钉（dynamic hip screw，DHS）、髓内钉固定系统3种内固定方法治疗，记录手术时间、术中出血量、隐性失血量、围术期失血总量、术后住院日、骨折愈合时间、Harris评分等数据并进行比较。结果: 髓内钉组16例，手术时间为55(20,120) min，术后平均住院日3(2,7) d，术中出血量为50(5,100) mL，隐性失血量为533.37(376.19,987.15) mL，失血总量为627.35(406.19,1037.16) mL，骨折平均愈合时间及最终Harris评分分别为6(3,9) 个月 和90.25(74,100)分；DHS组8例，手术时间为87.5(65,115) min，术后住院日5.5(2,17) d，术中出血量为100（50,300） mL，隐性失血量为278.11(202.43,849.97) mL，失血总量为580.19(368.55,899.97) mL，骨折平均愈合时间及最终Harris评分分别为5.5(4,12)个月和85.5(84,87)分；空心钉组4例，手术时间为47.5(35,75) min，术后住院日5(2,12) d，术中出血量为20（2,70） mL，隐性失血量为150(100.00,412.01) mL，失血总量为195.00(120.00,414.01) mL，骨折平均愈合时间及最终Harris评分分别为4(4,6)个月和80(61,97)分。髓内钉组和空心钉组手术时间明显少于DHS组，但前两组间差异无统计学意义（P=0.367）。3组患者术后住院日差异无统计学意义（P=0.053）。DHS组术中出血量明显高于另两组，而髓内钉组和空心钉组术中出血量差异无统计学意义（P=0.100）。隐性失血量髓内钉组显著增多，另两组间差异无统计学意义（P=0.134）。围术期失血总量空心钉组与其他两组比较相对较少，髓内钉组与DHS组差异无统计学意义（P=0.483）。患者平均随访时间4.74年（1~10年），采用空心钉治疗的一名患者术后3个月出现内固定失败。3组患者平均骨折愈合时间及最终随访时Harris评分差异无统计学意义（P＞0.05）。结论： 颈基底型骨折的发生率较低，无移位骨折患者可通过术前X线片确诊，对于骨折移位患者，建议完善术前CT+三维重建以确诊；闭合复位手术内固定治疗应作为首选治疗方式；采用DHS或髓内固定系统治疗效果较好。

Objective： To evaluate the rate of basicervical fractures and document their diagnosis and treatment. Methods: From January 2005 to May 2016, 28 basicervical fractures of the 832 trochanteric fractures were collected and evaluated. The patients were treated with multiple screws, dynamic hip screw (DHS), intramedullary nail. Via the operation time, postoperative hospitalization, loss of blood duration the operation, hidden blood loss, total blood loss, mean union time and the final follow-up Harris hip score, the characteristics of different internal fixations were compared and analyzed. Results: The incidence of basicervical fractures was 3.37% (28/832) in our study. In the intramedullary nail group (16 patients), the operation time was 55 (20,120) min, the postoperative hospitalization was 3(2, 7) d, the intraoperative blood loss was 50(5,100) mL, the hidden blood loss was 533.37 (376.19, 987.15) mL, and the total blood loss 627.35 (406.19, 1037.16) mL . The union time and final follow-up Harris score were 6 (3, 9) months and 90.25 (74,100) min. In the DHS group (8 patients), the operation time was 87.5 (65,115) min, the postoperative hospitalization was 5.5 (2, 17) d, the intraoperative blood loss was 100 (50,300) mL, the hidden blood loss was 278.11 (202.43, 849.97) mL, and the total blood loss 580.19 (368.55, 899.97) mL . The union time and final followup Harris score were 5.5 (4, 12) months and 85.5 (84, 87) min. In the multiple screws group (4 patients), the operation time was 47.5 (35, 75) min, the postoperative hospitalization was 5 (2, 12) d, the intraope-rative blood loss was 20 (2, 70) mL, the hidden blood loss was 150 (100.00, 412.01) mL, and the total blood loss 195.00 (120.00, 414.01) mL. The union time and final follow-up Harris score were 4 (4, 6) months and 80 (61, 97) min. The patients treated with multiple screws and intramedullary nail had a shorter operation time than the DNS group, but no obvious difference was found between the other two groups (P=0.367). Postoperative hospitalization had no significant difference among the three groups. The intraoperative bleeding was more in the DHS group, the other two groups had no significant difference (P=0.100). However, the hidden blood loss was more in the intramedullary nail group, the other two groups had no significant difference (P=0.134). The total blood loss in the intramedullary nail group was more than multiple screw group, similar to the DHS group (P=0.483). One patient treated with multiple screws underwent internal fixation failure three months after operation. The mean union time and final follow-up Harris scores had no significant difference among the three groups (P>0.05). Conclusion: Through this study, we found that the incidence of basicervical fractures is low. Fractures with no shift can be confirmed by preoperative X-ray. For displaced fractures, preoperative CT + 3D reconstruction is recommended. Surgical treatment by closed reduction and internal fixation with DHS or intramedullary nail is shown to be very effective.