Application Of Orthopedic Robot-assisted Hollow Screw Placement In Closed Reduction Internal Fixation Of Femoral Neck Fractures

ObjectiveComputer Assisted Orthopedic Surgery(CAOS)is a new surgical method for the treatment of femoral neck fracture.In this paper,the accuracy,safety and reliability of orthopedic robot assisted navigation cannulated screw placement in the treatment of femoral neck fracture were preliminarily explored by comparing the efficacy of orthopedic robot assisted navigation cannulated screw placement and traditional open hand cannulated screw placement in the treatment of femoral neck fracture.Materials and MethodsA retrospective study was carried out in this experiment.A total of 40 cases of femoral neck fractures admitted to the Second Hospital of Shandong University from 2019 to 2021 were included.According to the surgical methods,the cases were divided into the experimental group and the control group.There were 20 cases in the experimental group,11 males and 9 females,aged from 24 to 66 years old,with an average of(51.05±11.31)years old,including 4 cases of Garden Ⅰ and 16 cases of Garden Ⅱ.The hollow screw placement was completed with the assistance of orthopedic robots in the experimental group.In addition,there were 20 cases in the control group,including 14 males and 6 females,aged from 19 to 68 years old,with an average of(49.75±13.72)years old,including 3 cases of Garden Ⅰ and 17 cases of Garden Ⅱ.The control group adopted the traditional surgical method of percutaneous hollow screw placement.Three parallel hollow screws were placed in both the experimental group and the control group during internal fixation.The following data were collected and compared between the two groups:(1)operative time;(2)number of intraoperative fluoroscopy;(3)number of intraoperative drilling;(4)bleeding;(5)preoperative time;(6)incidence of complications during hospitalization,such as loosening or retraction of the internal fixation screws,lower limb deep vein thrombosis,pulmonary embolism,vascular and nerve injury,wound infection,delayed healing or non-healing,etc.;(7)parallelism of the three screws on the first postoperative review X-ray.deviation from the intended trajectory(neck stem angle and anterior tilt angle);(8)mean fracture healing time;and(9)Harris score of the hip joint at 6 months postoperative follow-up.ResultsPatients in the experimental group and the control group were successfully completed the operation.There was no postoperative wound infection or nonunion,no hollow screw withdrawal or loosening,no internal fixation rejection,no pulmonary embolism,no vascular and nerve injury and other complications.Until the end of the study,there was no ischemic necrosis of the femoral head.The operation time of the two groups was statistically different(P<0.05),and the operation time of the experimental group was shorter than that of the control group;there was a statistically significant difference in the number of fluoroscopy(P<0.05),and the number of fluoroscopy in the experimental group was significantly less than that in the control group.There was a statistically significant difference in the number of intraoperative drilling between the two groups(P<0.05),and the number of needle adjustment in the experimental group was less than that in the control group.The parallelism of the three cannulated screws between the two groups was statistically significant(P<0.05),and the parallelism of the experimental group was better.There was significant difference in the deviation angle between the hollow screw and the predetermined trajectory(neck stem angle and anteversion angle)between the two groups(P<0.05),and the experimental group was better than the control group.There was a statistically significant difference in the hip joint function score between the two groups 6 months after operation,and the experimental group was better than the control group.Conclusion1.The orthopedic robot can significantly reduce the number of intraoperative fluoroscopies,which will effectively reduce the radiation injury to patients and medical personnel.2.The orthopedic robot can significantly reduce the number of intraoperative guide pin adjustments,which is very beneficial to shorten the operation time,reduce intraoperative bleeding,and reduce the Medically-induced injury to the patient.3.The hollow screws placed with the assistance of the orthopedic robot have better parallelism with each other,and the deviation angle between the hollow screws and the neck stem angle and the anterior tilt angle is smaller,with more reasonable mechanical distribution and more reliable internal fixation.4.The postoperative hip function scores of patients with orthopedic robot-assisted surgery were higher than those of the control group,and the recovery of hip function was better.5.Orthopedic robot-assisted hollow screw placement for femoral neck fractures is a reliable surgical approach that can effectively improve the precision and safety of the operation.