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目的:改良2017年提出的难复性股骨转子间骨折分型并归纳其复位技巧。方法:回顾性分析2015年1月至2019年12月期间上海交通大学医学院附属第九人民医院骨科收治的17例难复性股骨转子间骨折患者资料（难复组）。男7例，女10例；年龄为（73.2 ± 16.1）岁。在2017分型基础上，重新将难复性股骨转子间骨折分为2型（难复2021分型）：Ⅰ型交锁型，根据交锁位置又分为3个亚型：ⅠA型（矢状位交锁）7例，ⅠB型（大转子交锁）1例，ⅠC型（小转子交锁）1例；Ⅱ型分离型，根据严重程度分为4个亚型：ⅡA型（矢状位分离）4例，ⅡB型（冠状位分离）1例，ⅡC型（旋转分离）1例，ⅡD型（完全分离）2例。所有患者根据不同分型采用相应的复位策略（如应用顶棒、钳夹及撬拨技术等）闭合复位髓内钉固定。将同期收治的132例非难复性股骨转子间骨折患者作为对照组。比较两组患者的骨折复位时间、术中出血量及末次随访时髋关节Harris评分等。结果:两组患者术前一般资料比较差异均无统计学意义（n P>0.05），具有可比性。难复性股骨转子间骨折中ⅠA型所占比例最高，为41.3%（7/17），其次是ⅡA型[23.6%（4/17）]。难复组患者的骨折复位时间[（44.6 ± 6.7）min]显著长于对照组患者[（39.2 ± 9.6）min]，差异有统计学意义（n P0.05）。n 结论:相对于“2017分型”，“难复2021分型”更简洁、易记，能直接提示相应的骨折复位技巧，应用这些复位技巧复位固定后的患者可获得与非难复性股骨转子间骨折患者相似的功能。“,”Objective:To revise the 2017 classification of irreducible intertrochanteric fractures and summarize reduction techniques of 2021 classification.Methods:A retrospective analysis was conducted of the 17 patients with irreducible intertrochanteric fracture who had been treated at Department of Orthopaedic Surgery, The Ninth People\'s Hospital of Shanghai, Shanghai Jiaotong University School of Medicine from January 2015 to December 2019. They were 7 males and 10 females, with an age of (73.2 ± 16.1) years. On the basis of 2017 classification, the irreducible intertrochanteric fractures were classified into 2 types in the present 2021 classification. Type Ⅰ were interlocking fractures which were further classified into 3 subtypes: type ⅠA were sagittal interlocking ones (7 cases), type ⅠB greater trochanter interlocking ones (one case) and type ⅠC lesser trochanter interlocking ones (one case). Type Ⅱ were separating fractures which were further classified into 4 subtypes: type ⅡA were sagittal separating ones (4 cases), type ⅡB coronal separating ones (one case), type ⅡC rotational separating ones(one case) and type ⅡD complete separating ones (2 cases). All patients were treated by closed reduction and intramedullary nailing with different reduction strategies corresponding to their fracture types (application of ejector rods, clamps or prying techniques, etc.). A total of 132 patients with reducible femoral intertrochanteric fracture who had been admitted during the same period were selected as the control group. The fracture reduction time, intraoperative blood loss and Harris hip score at the last follow-up were compared between the 2 groups.Results:The 2 groups were comparable because there was no significant difference in their preoperative general data (n P>0.05). Type ⅠA accounted for the highest proportion of irreducible intertrochanteric fractures [41.3% (7/17)], followed by type ⅡA [23.6% (4/17)]. The fracture reduction time [(44.6 ± 6.7) min] in the irreducible group was significantly longer than that in the control group [(39.2 ± 9.6) min] (n P0.05).n Conclusions:Compared with the “2017 classification” , the “2021 classification” is more concise and easy to remember, and can directly prompt the corresponding proper fracture reduction techniques. The patients with irreducible intertrochanteric fracture using proper reduction techniques can obtain functional recovery similar to that in the patients with reducible intertrochanteric fracture after reduction and fixation.