Liu Yajun, Wang Zhaodong, Xu Chen, Zhu Zhonglian, Duan Keyou, Guan Jianzhong
Department of Orthopedics, First Affiliated Hospital of Bengbu Medical College, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Dec 15;37(12):1471-1476. doi: 10.7507/1002-1892.202308051.
To investigate the early effectiveness of the Ti-Robot assisted femoral neck system (FNS) in the treatment of elderly Garden type Ⅱ and Ⅲ femoral neck fractures.
A retrospective analysis was conducted on the clinical data of 41 elderly patients with Garden type Ⅱ and Ⅲ femoral neck fractures who were admitted between December 2019 and August 2022 and met the selection criteria. Among them, 21 cases were treated with Ti-Robot assisted FNS internal fixation (study group), and 20 cases were treated solely with FNS internal fixation (control group). There was no significant difference in baseline data, including gender, age, side, cause of injury, time from injury to surgery, fracture Garden classification, and fracture line classification, between the two groups ( >0.05). Surgical effectiveness was evaluated based on parameters such as operation time (including incision time and total operation time), reduction level, number of dominant pin insertions, intraoperative fluoroscopy frequency, incision length, whether to extend the incision, need for assisted reduction, postoperative hospital stay, fracture healing time, incidence of osteonecrosis of the femoral head, postoperative visual analogue scale (VAS) score at 1 day, and Harris hip score at last follow-up.
The study group showed significantly shorter incision time, fewer dominant pin insertions, fewer instances of extended incisions, fewer intraoperative fluoroscopy frequency, and smaller incisions than the control group ( <0.05). There was no significant difference in total operation time, reduction level, and assisted reduction frequency between the two groups ( >0.05). Both groups achieved primary wound healing postoperatively, with no complications such as incision leakage or skin infection. All patients were followed up 12-24 months with an average of 14.6 months. Fractures healed in both groups, with no significant difference in healing time ( >0.05). There was no significant difference in postoperative hospital stay between the two groups ( >0.05). The study group showed significantly better VAS score at 1 day after operation and Harris hip score at last follow-up when compared to the control group ( <0.05). No complication such as internal fixation failure, fracture displacement, or hip joint varus occurred in both groups during the follow-up. Osteonecrosis of the femoral head occurred in 1 patient of the control group, while no was observed in the study group, and the difference in the incidence of osteonecrosis of the femoral head between the two groups was not significant ( =0.488).
Compared to sole FNS internal fixation treatment, Ti-Robot assisted FNS internal fixation for elderly Garden typeⅡ and Ⅲ femoral neck fractures can reduce incision time, achieve minimally invasive and accurate nail implantation, and decrease intraoperative fluoroscopy frequency, leading to improved postoperative hip joint function recovery.
探讨钛机器人辅助股骨颈系统（FNS）治疗老年GardenⅡ型和Ⅲ型股骨颈骨折的早期疗效。
回顾性分析2019年12月至2022年8月收治的41例符合入选标准的老年GardenⅡ型和Ⅲ型股骨颈骨折患者的临床资料。其中，21例采用钛机器人辅助FNS内固定治疗（研究组），20例单纯采用FNS内固定治疗（对照组）。两组患者的基线资料，包括性别、年龄、患侧、受伤原因、受伤至手术时间、骨折Garden分型及骨折线分型等，差异均无统计学意义（>0.05）。根据手术时间（包括切口时间和总手术时间）、复位程度、主钉置入次数、术中透视次数、切口长度、是否延长切口、是否需要辅助复位、术后住院时间、骨折愈合时间、股骨头坏死发生率、术后1天视觉模拟评分（VAS）及末次随访时Harris髋关节评分等指标评估手术疗效。
研究组的切口时间明显短于对照组，主钉置入次数更少，延长切口的情况更少，术中透视次数更少，切口更小（<0.05）。两组患者的总手术时间、复位程度及辅助复位次数差异均无统计学意义（>0.05）。两组患者术后均实现一期伤口愈合，无切口漏液或皮肤感染等并发症。所有患者均获随访12 - 24个月，平均14.6个月。两组骨折均愈合，愈合时间差异无统计学意义（>0.05）。两组患者术后住院时间差异无统计学意义（>0.05）。研究组术后1天的VAS评分及末次随访时的Harris髋关节评分均明显优于对照组（<0.05）。随访期间两组均未发生内固定失败、骨折移位或髋关节内翻等并发症。对照组有1例患者发生股骨头坏死，研究组未观察到，两组股骨头坏死发生率差异无统计学意义（=0.488）。
与单纯FNS内固定治疗相比，钛机器人辅助FNS内固定治疗老年GardenⅡ型和Ⅲ型股骨颈骨折可缩短切口时间，实现微创精准置钉，减少术中透视次数，促进术后髋关节功能恢复。
