Objective: To investigate the effectiveness and the advantage of fixation with percutaneous cannulated screws assisted by robot navigation in the treatment of femoral neck fractures by comparing with the conventional surgery.
Methods: Between January 2013 and December 2014, 20 patients with femoral neck fracture were treated by internal fixation with percutaneous cannulated screws assisted by robot navigation (navigation group), another 18 patients undergoing conventional surgery with manual positioning were chosen as the control group. There was no significant difference in gender, age, cause of injury, the injury side, time from injury to operation, and the classification of fractures between 2 groups (P > 0.05). The operation time, X-ray fluoroscopy time, blood loss, frequency of guide pin insertion, and healing time were recorded. At 1 week after operation, the parallel degree of screws was measured on the anteroposterior and lateral X-ray films; the Harris score was used to evaluate the hip function.
Results: All incisions of 2?groups healed by first intention after operation. There was no significant difference in operation time between 2?groups (t= -1.139, P=0.262). The blood loss, frequency of guide pin insertion, and X-ray fluoroscopy time of navigation group were significantly less than those of control group (P < 0.05). There were 2 screws penetrating into the joint cavity in control group. The patients were followed up 12-24 months with an average of 18 months. The navigation group got significantly better parallel degree of screws than control group on the anteroposterior and lateral X-ray films (t=25.021, P=0.000; t=18.659, P=0.000). Fractures healed in all patients of navigation group (100%), and the healing time was (21.8±2.8) weeks; fracture healed in 16 patients of control group (88.9%), and the healing time was (24.0 ± 3.7) weeks. There was no significant difference in healing rate and healing time between 2 groups (χ2=2.346, P=0.126; t=1.990, P=0.055). The Harris score of navigation group (87.1±3.7) was significantly higher than that of control group (79.3±4.7) at last follow-up (t= -5.689, P=0.000).
Conclusions: Cannulated screw fixation assisted by robot navigation is a good method to treat femoral neck fractures, which has the advantages of more accurate positioning, better hip function recovery, less surgical trauma, and shorter X-ray exposure time.
目的: 比较机器人导航下与传统经皮空心拉力螺钉内固定术治疗股骨颈骨折的疗效，探讨机器人导航的优势。.
方法: 回顾分析2013年1月－2014年12月，于机器人导航下行经皮空心拉力螺钉内固定术的20例股骨颈骨折患者临床资料（导航组），并与同期采用传统经皮空心拉力螺钉内固定术治疗的18例患者（对照组）进行比较。两组患者性别、年龄、致伤原因、受伤至手术时间、侧别及骨折类型等一般资料比较，差异均无统计学意义（P > 0.05），具有可比性。记录两组手术时间、术中透视时间、导针植入次数、术中出血量以及骨折愈合情况。于术后1周正、侧位X线片上测量并计算螺钉相互平行程度。术后12个月采用Harris评分标准对髋关节功能进行评价。.
结果: 两组术后切口均Ⅰ期愈合。导航组手术时间与对照组比较，差异无统计学意义（t= -1.139，P=0.262），但术中透视时间、导针植入次数以及术中出血量均显著低于对照组（P < 0.05）。术中对照组2枚螺钉穿透骨质进入关节腔，导航组无螺钉进入关节腔。两组患者均获随访，随访时间12～24个月，平均18个月。术后正、侧位X线片测量示，导航组螺钉相互平行程度显著优于对照组，比较差异有统计学意义（t=25.021，P=0.000；t=18.659，P=0.000）。X线片复查示，导航组骨折均愈合（100%），愈合时间为（21.8±2.8）周；对照组16例（88.9%）骨折愈合，愈合时间为（24.0±3.7）周。两组骨折愈合率以及愈合时间比较，差异均无统计学意义（χ2=2.346，P=0.126；t=1.990，P=0.055）。术后12个月，导航组髋关节功能Harris评分为（87.1±3.7）分，显著高于对照组的（79.3±4.7）分，比较差异有统计学意义（t= -5.689，P=0.000）。.
结论: 与传统术式相比，机器人导航下经皮空心拉力螺钉内固定术治疗股骨颈骨折定位准确，手术创伤小，术中X线暴露时间显著减少，髋关节功能恢复好。.
Keywords: Cannulated screw; Femoral neck fracture; Internal fixation; Robot navigation.