Xu Weizhen, Ding Zhenqi, Liu Hui, Zhang Jinhui, Xiong Yuanfei, Wu Jin
Department of Orthopedics, the 909th Hospital, Dongnan Hospital of Xiamen University, Zhangzhou Fujian, 363000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Jun 15;39(6):673-679. doi: 10.7507/1002-1892.202502067.
To investigate the effectiveness of Holosight robotic navigation-assisted percutaneous cannulated screw fixation for femoral neck fractures.
A retrospective analysis was conducted on 65 patients with femoral neck fractures treated with cannulated screw fixation between January 2022 and February 2024. Among them, 31 patients underwent robotic navigation-assisted screw placement (navigation group), while 34 underwent conventional freehand percutaneous screw fixation (freehand group). Baseline characteristics, including age, gender, fracture side, injury mechanism, Garden classification, Pauwels classification, and time from injury to operation, showed no significant differences between the two groups ( >0.05). The operation time, intraoperative blood loss, fluoroscopy frequency, fracture healing time, and complications were recorded and compared, and hip function was evaluated by Harris score at last follow-up. Postoperative anteroposterior and lateral hip X-ray films were taken to assess screw distribution accuracy, including deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex.
No significant difference was observed in operation time between the two groups ( >0.05). However, the navigation group demonstrated superior outcomes in intraoperative blood loss, fluoroscopy frequency, deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex ( <0.05). No incision infections or deep vein thrombosis occurred. All patients were followed up 12-18 months (mean, 16 months). In the freehand group, 1 case suffered from cannulated screw dislodgement and nonunion secondary to osteonecrosis of femoral head at 1 year after operation, 1 case suffered from screw penetration secondary to osteonecrosis of femoral head at 5 months after operation; and 1 case suffered from nonunion secondary to osteonecrosis of femoral head at 6 months after operation in the navigation group. All the 3 patients underwent internal fixators removal and total hip arthroplasty. There was no significant difference in the incidence of complications between the two groups ( >0.05). The fracture healing time and hip Harris score at last follow-up in the navigation group were significantly better than those in the freehand group ( <0.05).
Compared to freehand percutaneous screw fixation, Holosight robotic navigation-assisted cannulated screw fixation for femoral neck fractures achieves higher precision, reduced intraoperative radiation exposure, smaller incisions, and superior postoperative hip function recovery.
探讨Holosight机器人导航辅助下经皮空心螺钉固定治疗股骨颈骨折的有效性。
对2022年1月至2024年2月期间接受空心螺钉固定治疗的65例股骨颈骨折患者进行回顾性分析。其中，31例患者接受机器人导航辅助螺钉置入（导航组），34例接受传统徒手经皮螺钉固定（徒手组）。两组患者的基线特征，包括年龄、性别、骨折侧、损伤机制、Garden分型、Pauwels分型以及受伤至手术的时间，差异均无统计学意义（>0.05）。记录并比较两组患者的手术时间、术中出血量、透视次数、骨折愈合时间及并发症情况，末次随访时采用Harris评分评估髋关节功能。术后拍摄髋关节正侧位X线片，评估螺钉分布准确性，包括与股骨颈轴线的偏差、螺钉间平行度以及螺钉与股骨颈皮质的距离。
两组患者手术时间差异无统计学意义（>0.05）。然而，导航组在术中出血量、透视次数、与股骨颈轴线的偏差、螺钉间平行度以及螺钉与股骨颈皮质的距离方面表现更优（<0.05）。未发生切口感染或深静脉血栓形成。所有患者均获随访12 - 18个月（平均16个月）。徒手组1例患者术后1年出现空心螺钉移位并继发股骨头坏死致骨不连，1例患者术后5个月因股骨头坏死出现螺钉穿透；导航组1例患者术后6个月因股骨头坏死出现骨不连。3例患者均接受内固定取出及全髋关节置换术。两组并发症发生率差异无统计学意义（>0.05）。导航组骨折愈合时间及末次随访时髋关节Harris评分均显著优于徒手组（<0.05）。
与徒手经皮螺钉固定相比，Holosight机器人导航辅助下经皮空心螺钉固定治疗股骨颈骨折具有更高的精度、减少术中辐射暴露、切口更小以及术后髋关节功能恢复更佳的优点。
