COMPARATIVE STUDY ON FIXATION WITH PERCUTANEOUS CANNULATED SCREWS ASSISTED BY ROBOT NAVIGATION AND CONVENTIONAL SURGERY WITH MANUAL POSITIONING FOR FEMORAL NECK FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

TONGYi ,  LUOXiaozhong , WUGang , SHIWeixiang

Department of Orthopedics, the Fourth People’s Hospital of Zigong, Zigong Sichuan, 643000, P.R.China;

Corresponding author：

LUOXiaozhong, Email: luoxiaozhonglxz@sina.cn

Keywords：

Robot navigation; Femoral neck fracture; Cannulated screw; Internal fixation

DOI：

10.7507/1002-1892.20160139

Video：

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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). Conclusion 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.

Citation： TONGYi, LUOXiaozhong, WUGang, SHIWeixiang. COMPARATIVE STUDY ON FIXATION WITH PERCUTANEOUS CANNULATED SCREWS ASSISTED BY ROBOT NAVIGATION AND CONVENTIONAL SURGERY WITH MANUAL POSITIONING FOR FEMORAL NECK FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(6): 685-689. doi: 10.7507/1002-1892.20160139 Copy

1.	Thorngren KG, Hommel A, Norrman P, et al. Epidemiology of femoral neck fractures. Injury, 2002, 33 Suppl 3: C1-7.
2.	Shah AK, Eissler J, Radomisli T, et al. Algorithms for the treatment of femoral neck fractures. Clin Orthop Relat Res, 2002, (399): 28-34.
3.	Probe R, Ward R. Internal fixation of femoral neck fractures. J Am Acad Orthop Surg, 2006, 14(9): 565-571.
4.	Hamelinck HK, Haagmans M, Snoeren MM, et al. Safety of cornputer-assisted surgery for cannulated hip screws. Clin Orthop Relat Res, 2007, 455: 241-245.
5.	Gjertsen JE, Vinje T, Engesaeter LB, et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg (Am), 2010, 92(3): 619-628.
6.	钱学峰, 徐能, 蒋富贵, 等. 经皮空心螺钉内固定治疗股骨颈骨折. 中华创伤骨科杂志, 2013, 15(5): 453-454.
7.	Aggarwal A, Singh M, Aggarwal AN, et al. Assessment of interobserver variation in Garden classification and management of fresh intracapsular femoral neck fracture in adults. Chin J Traumatol, 2014, 17(2): 99-102.
8.	Karanicolas PJ, Bhandari M, Walter SD, et al. Interobserver reliability of classification systems to rate the quality of femoral neck fracture reduction. J Orthop Trauma, 2009, 23(6): 408-412.
9.	Sağlam N, Küçükdurmaz F, Kivilcim H, et al. Biomechanical comparison of antirotator compression hip screw and cannulated screw fixations in the femoral neck fractures. Acta Orthop Traumatol Turc, 2014, 48(2): 196-201.
10.	Liebergall M, Ben-David D, Weil Y, et al. Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg (Am), 2006, 88(8): 1748-1754．.
11.	Kumar MN, Belehalli P, Ramachandra P. PET/CT study of temporal variations in blood flow to the femoral head following low-energy fracture of the femoral neck. Orthopedics, 2014, 37(6): e563-570.
12.	周力, 王豫, 王红建, 等. 双平面骨科机器人系统辅助股骨颈骨折内固定的实验研究. 中华创伤骨科杂志, 2009, 11(2): 147-151.
13.	Baumgaertner MR, Higgins TF. Femoral neck fractures//Buchholz RW, Heckman JD. Rockwood and Green’s fractures in adults. Philadelphia: Lippincott Williams&Wilkins, 2001: 1579-1634.
14.	Zwingmann J, Hauschild O, Bode G, et al. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg, 2013, 133(9): 1257-1265.
15.	Zwingmann J, Konrad G, Kotter E, et al. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res, 2009, 467(7): 1833-1838.
16.	Rampersaud YR, Foley KT, Shen AC, et al. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine (Phila Pa 1976), 2000, 25(20): 2637-2645.
17.	赵春鹏, 王军强, 王豫, 等. 双平面骨科机器人系统辅助股骨颈骨折空心螺钉内固定术的实验研究. 中华创伤骨科杂志, 2006, 8(1): 50-55.
18.	杨欢, 周方, 田耘, 等. 股骨粗隆部骨折内固定失败原因分析. 北京大学学报(医学版), 2011, 43(5): 699-702.

1. Thorngren KG, Hommel A, Norrman P, et al. Epidemiology of femoral neck fractures. Injury, 2002, 33 Suppl 3: C1-7.
2. Shah AK, Eissler J, Radomisli T, et al. Algorithms for the treatment of femoral neck fractures. Clin Orthop Relat Res, 2002, (399): 28-34.
3. Probe R, Ward R. Internal fixation of femoral neck fractures. J Am Acad Orthop Surg, 2006, 14(9): 565-571.
4. Hamelinck HK, Haagmans M, Snoeren MM, et al. Safety of cornputer-assisted surgery for cannulated hip screws. Clin Orthop Relat Res, 2007, 455: 241-245.
5. Gjertsen JE, Vinje T, Engesaeter LB, et al. Internal screw fixation compared with bipolar hemiarthroplasty for treatment of displaced femoral neck fractures in elderly patients. J Bone Joint Surg (Am), 2010, 92(3): 619-628.
6. 钱学峰, 徐能, 蒋富贵, 等. 经皮空心螺钉内固定治疗股骨颈骨折. 中华创伤骨科杂志, 2013, 15(5): 453-454.
7. Aggarwal A, Singh M, Aggarwal AN, et al. Assessment of interobserver variation in Garden classification and management of fresh intracapsular femoral neck fracture in adults. Chin J Traumatol, 2014, 17(2): 99-102.
8. Karanicolas PJ, Bhandari M, Walter SD, et al. Interobserver reliability of classification systems to rate the quality of femoral neck fracture reduction. J Orthop Trauma, 2009, 23(6): 408-412.
9. Sağlam N, Küçükdurmaz F, Kivilcim H, et al. Biomechanical comparison of antirotator compression hip screw and cannulated screw fixations in the femoral neck fractures. Acta Orthop Traumatol Turc, 2014, 48(2): 196-201.
10. Liebergall M, Ben-David D, Weil Y, et al. Computerized navigation for the internal fixation of femoral neck fractures. J Bone Joint Surg (Am), 2006, 88(8): 1748-1754．.
11. Kumar MN, Belehalli P, Ramachandra P. PET/CT study of temporal variations in blood flow to the femoral head following low-energy fracture of the femoral neck. Orthopedics, 2014, 37(6): e563-570.
12. 周力, 王豫, 王红建, 等. 双平面骨科机器人系统辅助股骨颈骨折内固定的实验研究. 中华创伤骨科杂志, 2009, 11(2): 147-151.
13. Baumgaertner MR, Higgins TF. Femoral neck fractures//Buchholz RW, Heckman JD. Rockwood and Green’s fractures in adults. Philadelphia: Lippincott Williams&Wilkins, 2001: 1579-1634.
14. Zwingmann J, Hauschild O, Bode G, et al. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg, 2013, 133(9): 1257-1265.
15. Zwingmann J, Konrad G, Kotter E, et al. Computer-navigated iliosacral screw insertion reduces malposition rate and radiation exposure. Clin Orthop Relat Res, 2009, 467(7): 1833-1838.
16. Rampersaud YR, Foley KT, Shen AC, et al. Radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion. Spine (Phila Pa 1976), 2000, 25(20): 2637-2645.
17. 赵春鹏, 王军强, 王豫, 等. 双平面骨科机器人系统辅助股骨颈骨折空心螺钉内固定术的实验研究. 中华创伤骨科杂志, 2006, 8(1): 50-55.
18. 杨欢, 周方, 田耘, 等. 股骨粗隆部骨折内固定失败原因分析. 北京大学学报(医学版), 2011, 43(5): 699-702.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARATIVE STUDY ON FIXATION WITH PERCUTANEOUS CANNULATED SCREWS ASSISTED BY ROBOT NAVIGATION AND CONVENTIONAL SURGERY WITH MANUAL POSITIONING FOR FEMORAL NECK FRACTURES

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