This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on http://medinform.jmir.org/, as well as this copyright and license information must be included.
Femoral neck fracture is a common type of hip fracture. Conventional surgical treatment aims at fixing the fracture site with screws and then gradually promoting bone healing. A robot-assisted orthopedic surgery system is computer technology applied to surgical treatment.
This study aimed to explore the therapeutic effect and prognostic value of percutaneous cannulated screw internal fixation using robot-assisted positioning in patients with femoral neck fractures.
From July 2018 to September 2019, 42 cases of femoral neck fracture admitted to the Second Affiliated Hospital of Luohe Medical College were randomly and averagely divided into control and study groups. The patients in the control group were treated with conventional percutaneous cannulated screw internal fixation, while the patients in the study group were treated with robot-assisted percutaneous cannulated screw fixation during surgical treatment. We compared the treatment conditions and results of the operation between the 2 groups. The Harris score was used to evaluate the treatment efficacy. The state of fracture healing was followed up and compared between the 2 groups.
The duration of the operation was shorter, there was less fluoroscopy use, and there were fewer drilled holes in the study group than in the control group (all,
The use of robotic positioning aids in the treatment of femoral neck fractures with percutaneous cannulated screw fixation can effectively improve the efficiency of surgery, shorten the duration of surgery, and reduce the radiation damage to patients. Meanwhile, it improves postoperative treatment and recovery rates of the patients and shortens the fracture healing time.
Femoral neck fracture is a common type of hip fracture. Due to the special location of the fracture, the incidence of femoral neck fracture necrosis is high, and the prognosis is poor, which seriously affects the patient’s activities of daily life [
With improvement in medical technology and the rapid development of minimally invasive surgery, surgical robots were introduced in the 1980s and first used in brain surgery in 1985 [
A robot-assisted orthopedic surgery system is computer technology applied to surgical treatment. It can process the patient’s imaging information through computer algorithms to help doctors determine the appropriate treatment model and assist in surgical treatment [
From July 2018 to September 2019, 42 patients with femoral neck fractures admitted to the Second Affiliated Hospital of Luohe Medical College were included. Femoral neck fractures were mainly defined by imaging examination including X-ray, CT, and magnetic resonance imaging. At present, the Garden classification is the most commonly used classification standard and can be divided into 4 types according to the degree of fracture displacement [
All patients were randomly divided into 2 groups (control group and study group), with 21 patients in each group. Oral consent was obtained from patients. Basic clinical data and clinical data were obtained from electronic medical records. Electronic medical information included demographic data, general surgical conditions, and state of fracture healing.
First, we compared the general surgical conditions between the 2 groups, including the duration of operation, frequency of intraoperative fluoroscopy usage, amount of intraoperative blood loss, and number of intraoperative holes. Second, the number of excellent ratings of the treatment was compared between the 2 groups. We used the Harris score [
The patients in the control group were treated using a traditional reduction operation with percutaneous cannulated screw internal fixation. The patients were placed in a supine position and anesthetized in the subarachnoid space. After completing anatomical reduction of the fracture site under C-arm fluoroscopy, 3 Kirschner wires were used to treat the patients. C-arm fluoroscopy was used again to monitor the lateral position of the hip joint, as well as the placement and depth of the Kirschner wires. If there was an abnormality in the position of the Kirschner wires, they were pulled out for repositioning. The needle tip position was kept 0.5 mm below the cartilage of the femoral head. After the position was considered satisfactory, the length of the Kirschner wires was measured. This was followed by inserting the cannulated screws in sequence, according to the position and depth of the Kirschner wires. Finally, C-arm fluoroscopy was used again to confirm whether the cannulated screw was successfully implanted. If successful, the wound was sutured.
The patients in the study group were treated using the TIANJI robotic positioning system for orthopedic surgery (Catalog, HY001512, TINAVI Medical Technologies Co. Ltd, Beijing, China) as adjuvant therapy in conventional surgical procedures, which is the third generation of the TIANJI orthopedic robot. At first, a treatment model of femoral neck fracture was established. After completing the anatomical reduction, the robot was placed in a suitable position, and the preliminary positioning was completed. Then, the robot was covered with a sterile plastic film and placed in the preliminary marked position, the accuracy of which was determined and fixed. A C-arm X-ray monitor was placed at the lateral hip side. Based on the collected patient data, follow-up surgical planning was made. After all plans and preparation were completed, 3 hollow screws were inserted according to standards. The entire length of the hollow screws was calculated, and the mechanical arm of the robot started to position and navigate the screw. After the position was confirmed, the hollow screw was inserted. Finally, C-arm fluoroscopy was used again to confirm the location, and the wound was sutured after confirmation. Both groups of patients underwent routine anti-infective treatment, with the follow-up time set at 6 months.
SPSS 25.0 software was used for statistical analysis of the data. The categorical variables are presented as frequencies and percentages. Continuous variables are described using mean and SD. We used
In the control group, the patient age range was 29-67 years, and the mean (SD) age was 51.33 years (4.30 years). The disease course was 3-17 days, and the mean (SD) disease course was 6.83 days (3.91 days). There were 14 men and 7 women. The causes of injury were described as the following: 10 cases of car accidents, 6 cases of falls, and 5 cases of sports. There were 4 Garden II cases, 12 Garden III cases, and 5 Garden IV cases according to the Garden classification.
In the study group, patients were 31-68 years old, with a mean (SD) age of 51.86 years (4.89 years). The clinical course of disease was 2-19 days, with a mean (SD) course of 6.67 days (3.68 days). There were 12 male patients and 9 female patients. The causes of injury were stated as the following: 9 cases of car accidents, 8 cases of falls, and 4 cases of sports. There were 5 Garden II cases, 13 Garden III cases, and 3 Garden IV cases according to the Garden classification. The general difference in the clinical data between these 2 groups was not statistically significant (
The duration of surgery was shorter, there was less use of intraoperative fluoroscopy, and there were fewer drilled holes in the study group than in the control group (all,
Comparison of the general surgical characteristics of the operation between the 2 groups of patients.
Characteristics | Control group (n=21) | Study group (n=21) | ||
Operation duration (minutes), mean (SD) | 88.29 (14.29) | 64.12 (10.86) | 6.171 | <.001 |
Frequency of intraoperative fluoroscopy, n | 19.86 (3.29) | 12.20 (2.11) | 9.098 | <.001 |
Intraoperative blood loss (mL), mean (SD) | 76.92 (8.29) | 74.51 (7.48) | 0.989 | .33 |
Frequency of intraoperative drilling, n | 10.71 (2.92) | 5.52 (1.43) | 7.315 | <.001 |
adegrees of freedom: 40.
The Harris score of the study group was significantly higher than that of the control group (
Comparison of the excellent and good ratings of the treatment between the 2 groups of patients.
Ratings | Control group (n=21) | Study group (n=21) | Comparison | |
Harris score, mean (SD) | 88.86 (9.24) | 94.24 (7.52) | t40=2.060 | .045 |
Excellent, n (%) | 4 (19) | 13 (62) | χ1=8.005 | .005 |
Good, n (%) | 8 (38) | 6 (29) | χ1=0.429 | .51 |
Average, n (%) | 7 (33) | 2 (10) | χ1=2.263 | .13 |
Poor, n (%) | 2 (10) | 0 (0) | χ1=0.525 | .47 |
Excellent and good, n (%) | 12 (57) | 19 (90) | χ1=6.035 | .01 |
The fracture healing rate in the study group was 100% (21/21), and in the control group, it was 86% (18/21); the difference was not statistically significant (
Comparison of fracture healing rates between the 2 groups of patients.
Fracture healing | Control group (n=21) | Study group (n=21) | Comparison | |
Healed cases, n (%) | 18 (86) | 21 (100) | χ1=1.436 | .23 |
Healing duration (months), mean (SD) | 4.45 (0.48) | 3.98 (0.33) | .001 |
There was a 49-year-old male patient in the study group with a fracture of the right femoral neck. He was treated with robot-assisted percutaneous cannulated screw internal fixation. Before the surgery, the treatment model for the femoral neck fracture was established. After anatomical reduction, the robot was placed in a suitable position to complete the preliminary positioning. The C-arm X-ray machine was used to obtain the intraoperative fluoroscopy image containing the robot positioning mark points and transmit it to the host workstation for registration calculation. According to the images collected during the operation, the screw path planning was carried out in the master control system planning software based on the typical marking points and bony landmarks. The path of the femoral neck screw channel was confirmed by anteroposterior and lateral biplane images, which are displayed in
Application of robot positioning for cannulated screw internal fixation in the treatment of femoral neck fracture, with preoperative planning by the orthopedic surgery robot for the (A) anterioposterior femoral neck and (B) lateral femoral neck view. (C) Intraoperative fluoroscopy-assisted guiding of the needles and (D) postoperative radiograph after cannulated screw femoral fixation.
Radiograph of the femoral neck after the surgery: (A) preoperative (B) postoperative, (C) 3 months postoperative, (D) 1 year postoperative.
In the surgical treatment of femoral neck fractures, to ensure the success of the anatomical reduction of the fracture site, the key is using cannulated screws for internal fixation, which is currently followed in clinical practice. Choosing the appropriate implantation site and implantation depth are the key considerations during the procedure [
The results showed that the study group had shorter surgery lengths, less use of intraoperative fluoroscopy, and fewer drilled holes than the control group (all,
The Harris score of the study group was significantly higher than that of the control group (
At the same time, the follow-up results showed that the rate of fracture healing in the study group (21/21, 100%) was slightly higher than that in the control group. There were no complications such as loosening of internal fixation, fracture displacement, necrosis, or infection in the study group. The fracture healing time of the study group was significantly shorter than that in the control group (
In summary, the use of orthopedic surgical robots for auxiliary treatment of femoral neck fractures with percutaneous cannulated screw fixation can effectively improve the efficiency of drilling and fixation, help to shorten the duration of surgery, reduce radiation damage to patients, and improve the safety of surgery. The femoral reduction effect is significantly improved, and patients achieve more remarkable treatment outcomes. At the same time, the use of robot-assisted surgery can shorten the recovery time of patients after surgery, improve the healing rate of fractures, and improve patients’ prognosis.
computed tomography
This study was supported by the Project of Top Youth Talents of Luohe (grant number LBJZ210602).
ZS conducted the study, had full access to all the data, and takes responsibility for the integrity of the data and the accuracy of the data analysis. ZX and ZS obtained funding. WL designed the research and drafted the manuscript. WD and LZ performed the statistical analysis. YD and LJ collected the images. ZS contributed to the acquisition and interpretation of the data. YL critically reviewed and revised the article for important intellectual content. All authors approved the final manuscript and decided to submit the article for publication.
None declared.