Short-term effectiveness of robot-guided femoral neck system combined with cannulated compression screw fixation in treatment of femoral neck fracture in young and middle-aged patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Zhaodong , LIU Yajun , XU Chen , DUAN Keyou , ZHU Zhonglian , WU Min ,  GUAN Jianzhong

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical University, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233004, P. R. China;

Corresponding?author：

GUAN Jianzhong, Email: guanjianzhong@bbmc.edu.cn

Keywords：

Femoral neck fracture; robot-guided surgery; femoral neck system; cannulated compression screw; short-term effectiveness

DOI：

10.7507/1002-1892.202406075

Video：

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Objective To investigate short-term effectiveness of robot-guided femoral neck system (FNS) combined with cannulated compression screw (CCS) fixation in treatment of femoral neck fracture in young and middle-aged patients. Methods A clinical data of 49 young and middle-aged patients with femoral neck fractures, who met the selection criteria and admitted between January 2021 and June 2023, was retrospectively analyzed. After reduction of femoral neck fractures, 27 cases were treated with robot-guided FNS fixation (FNS group) and 22 cases with robot-guided FNS and CCS fixation (FNS+CCS group). There was no significant difference in baseline data such as gender, age, cause of fracture, time from fracture to operation, fracture side, and classification (Garden classification and Pauwels classification) between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, the time when the patient began bearing weight, and hip joint pain and functional scores (VAS score and Harris score) at last follow-up for two groups were recorded. Imaging re-examination was taken to evaluate the quality of fracture reduction, fracture healing, as well as the occurrence of fracture non-union, osteonecrosis of the femoral head, and femoral neck shortening. Results All operations were successfully completed and the incisions healed by first intention. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05), and the intraoperative fluoroscopy frequency in FNS+CCS group significantly increased compared to FNS group (P<0.05). All patients were followed up 12-18 months (mean, 14.1 months). Imaging re-examination showed that there was no significant difference in fracture reduction quality between the two groups (P>0.05), but the fracture healing time was significantly shorter in FNS+CCS group than in FNS group, and weight-bearing began earlier (P<0.05). The incidences of femoral neck shortening, fracture non-union, and osteonecrosis of the femoral head were lower in FNS+CCS group than in FNS group, and there was significant difference in the incidence of femoral neck shortening between groups (P<0.05). At last follow-up, there was no significant difference in VAS scores between the two groups (P>0.05). However, the Harris score was significantly higher in FNS+CCS group than in FNS group (P<0.05). Conclusion Compared with FNS fixation alone, robot-guided FNS combined with CCS fixation in the treatment of femoral neck fractures in young and middle-aged patients has obvious advantages in terms of early weight bearing and fracture healing, improves fracture healing rate, effectively prevents postoperative complications, and can obtain good short-term effectiveness.

Citation： WANG Zhaodong, LIU Yajun, XU Chen, DUAN Keyou, ZHU Zhonglian, WU Min, GUAN Jianzhong. Short-term effectiveness of robot-guided femoral neck system combined with cannulated compression screw fixation in treatment of femoral neck fracture in young and middle-aged patients. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(10): 1229-1235. doi: 10.7507/1002-1892.202406075 Copy

1.	Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury, 2021, 52(8): 2116-2125.
2.	Rajnish RK, Srivastava A, Rathod PM, et al. Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and meta-analysis. J Orthop, 2022, 32: 52-59.
3.	Hu H, Cheng J, Feng M, et al. Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients. J Orthop Surg Res, 2021, 16(1): 370. doi: 10.1186/s13018-021-02517-z.
4.	Gupta GK, Rai A, Mandal S, et al. Comparison of femoral neck system versus cannulated cancellous screws for the fixation of femoral neck fracture in young adults: a systematic review and meta-analysis. Cureus, 2022, 14(11): e32011. doi: 10.7759/cureus.32011.
5.	Davidson A, Blum S, Harats E, et al. Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review. Int Orthop, 2022, 46(9): 2105-2115.
6.	Vazquez O, Gamulin A, Hannouche D, et al. Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes. J Orthop Surg Res, 2021, 16(1): 477. doi: 10.1186/s13018-021-02622-z.
7.	He C, Lu Y, Wang Q, et al. Comparison of the clinical efficacy of a femoral neck system versus cannulated screws in the treatment of femoral neck fracture in young adults. BMC Musculoskelet Disord, 2021, 22(1): 994. doi: 10.1186/s12891-021-04888-0.
8.	Augat P, Bliven E, Hackl S. Biomechanics of femoral neck fractures and implications for fixation. J Orthop Trauma, 2019, 33 Suppl 1: S27-S32.
9.	Zhou Y, Li Z, Lao K, et al. Femoral neck system vs cannulated screws on treating femoral neck fracture: a meta-analysis and system review. Front Surg, 2023, 10: 1224559. doi: 10.3389/fsurg.2023.1224559.
10.	阿里木江·玉素甫, 阿卜杜吾普爾·海比爾, 阿不都拉·阿不來提, 等. 股骨頸動力交叉釘聯合空心釘治療PauwelsⅡ型中青年股骨頸骨折的有限元分析[J/OL]. 中國組織工程研究(2024-01-20) [2024-08-26]. http://kns.cnki.net/kcms/detail/21.1581.R.20240125.1610.006.html.
11.	劉亞軍, 王照東, 徐陳, 等. 天璣骨科機器人輔助股骨頸動力交叉釘系統微創治療老年Garden Ⅱ、Ⅲ型股骨頸骨折早期臨床療效. 中國修復重建外科雜志, 2023, 37(12): 1471-1476.
12.	Sepehri A, Martinson J, Marchand LS, et al. Measuring lateral screw protuberance is a clinically accurate method for quantifying femoral neck shortening. J Orthop Trauma, 2020, 34(11): 600-605.
13.	荊玉龍, 張樹棟, 韓紫音, 等. 骨科機器人輔助股骨頸動力交叉釘系統治療新鮮股骨頸骨折的近期療效. 中國修復重建外科雜志, 2022, 36(8): 946-950.
14.	趙興龍, 申建軍, 馮康虎, 等. 骨科機器人輔助下F釘技術與倒三角平行釘治療不穩定型股骨頸骨折的療效比較. 中國骨傷, 2024, 37(2): 129-134.
15.	Kalavrytinos D, Koutserimpas C, Kalavrytinos I, et al. Expanding robotic arm-assisted knee surgery: the first attempt to use the system for knee revision arthroplasty. Case Rep Orthop, 2020, 2020: 4806987. doi: 10.1155/2020/4806987.
16.	嚴才平, 王星寬, 向超, 等. 股骨頸動力交叉釘系統與空心加壓螺釘治療中青年股骨頸骨折的療效比較. 中國修復重建外科雜志, 2021, 35(10): 1286-1292.
17.	Wang X, Zhang Y, Lou L, et al. Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study. J Orthop Surg Res, 2023, 18(1): 633. doi: 10.1186/s13018-023-04070-3.
18.	Fan Z, Chen P, Yu X, et al. Biomechanical study of femoral neck system for young patients with nonanatomically reduced femoral neck fractures: a finite element. BMC Musculoskelet Disord, 2023, 24(1): 54. doi: 10.1186/s12891-022-06124-9.
19.	Stegelmann SD, Butler JT, Mathews DJ, et al. Survivability of the femoral neck system for the treatment of femoral neck fractures in adults. Eur J Orthop Surg Traumatol, 2023, 33(6): 2555-2563.
20.	葛雙雷, 王雪飛, 劉亮, 等. 股骨頸動力交叉釘系統聯合支撐空心螺釘對伴后內側粉碎的中青年股骨頸骨折的療效研究. 中華醫學雜志, 2023, 103(21): 1631-1637.

1. Fan Z, Huang Y, Su H, et al. How to choose the suitable FNS specification in young patients with femoral neck fracture: A finite element analysis. Injury, 2021, 52(8): 2116-2125.
2. Rajnish RK, Srivastava A, Rathod PM, et al. Does the femoral neck system provide better outcomes compared to cannulated screws fixation for the management of femoral neck fracture in young adults? A systematic review of literature and meta-analysis. J Orthop, 2022, 32: 52-59.
3. Hu H, Cheng J, Feng M, et al. Clinical outcome of femoral neck system versus cannulated compression screws for fixation of femoral neck fracture in younger patients. J Orthop Surg Res, 2021, 16(1): 370. doi: 10.1186/s13018-021-02517-z.
4. Gupta GK, Rai A, Mandal S, et al. Comparison of femoral neck system versus cannulated cancellous screws for the fixation of femoral neck fracture in young adults: a systematic review and meta-analysis. Cureus, 2022, 14(11): e32011. doi: 10.7759/cureus.32011.
5. Davidson A, Blum S, Harats E, et al. Neck of femur fractures treated with the femoral neck system: outcomes of one hundred and two patients and literature review. Int Orthop, 2022, 46(9): 2105-2115.
6. Vazquez O, Gamulin A, Hannouche D, et al. Osteosynthesis of non-displaced femoral neck fractures in the elderly population using the femoral neck system (FNS): short-term clinical and radiological outcomes. J Orthop Surg Res, 2021, 16(1): 477. doi: 10.1186/s13018-021-02622-z.
7. He C, Lu Y, Wang Q, et al. Comparison of the clinical efficacy of a femoral neck system versus cannulated screws in the treatment of femoral neck fracture in young adults. BMC Musculoskelet Disord, 2021, 22(1): 994. doi: 10.1186/s12891-021-04888-0.
8. Augat P, Bliven E, Hackl S. Biomechanics of femoral neck fractures and implications for fixation. J Orthop Trauma, 2019, 33 Suppl 1: S27-S32.
9. Zhou Y, Li Z, Lao K, et al. Femoral neck system vs cannulated screws on treating femoral neck fracture: a meta-analysis and system review. Front Surg, 2023, 10: 1224559. doi: 10.3389/fsurg.2023.1224559.
10. 阿里木江·玉素甫, 阿卜杜吾普爾·海比爾, 阿不都拉·阿不來提, 等. 股骨頸動力交叉釘聯合空心釘治療PauwelsⅡ型中青年股骨頸骨折的有限元分析[J/OL]. 中國組織工程研究(2024-01-20) [2024-08-26]. http://kns.cnki.net/kcms/detail/21.1581.R.20240125.1610.006.html.
11. 劉亞軍, 王照東, 徐陳, 等. 天璣骨科機器人輔助股骨頸動力交叉釘系統微創治療老年Garden Ⅱ、Ⅲ型股骨頸骨折早期臨床療效. 中國修復重建外科雜志, 2023, 37(12): 1471-1476.
12. Sepehri A, Martinson J, Marchand LS, et al. Measuring lateral screw protuberance is a clinically accurate method for quantifying femoral neck shortening. J Orthop Trauma, 2020, 34(11): 600-605.
13. 荊玉龍, 張樹棟, 韓紫音, 等. 骨科機器人輔助股骨頸動力交叉釘系統治療新鮮股骨頸骨折的近期療效. 中國修復重建外科雜志, 2022, 36(8): 946-950.
14. 趙興龍, 申建軍, 馮康虎, 等. 骨科機器人輔助下F釘技術與倒三角平行釘治療不穩定型股骨頸骨折的療效比較. 中國骨傷, 2024, 37(2): 129-134.
15. Kalavrytinos D, Koutserimpas C, Kalavrytinos I, et al. Expanding robotic arm-assisted knee surgery: the first attempt to use the system for knee revision arthroplasty. Case Rep Orthop, 2020, 2020: 4806987. doi: 10.1155/2020/4806987.
16. 嚴才平, 王星寬, 向超, 等. 股骨頸動力交叉釘系統與空心加壓螺釘治療中青年股骨頸骨折的療效比較. 中國修復重建外科雜志, 2021, 35(10): 1286-1292.
17. Wang X, Zhang Y, Lou L, et al. Robotic-assisted systems for the safe and reliable treatment of femoral neck fractures: retrospective cohort study. J Orthop Surg Res, 2023, 18(1): 633. doi: 10.1186/s13018-023-04070-3.
18. Fan Z, Chen P, Yu X, et al. Biomechanical study of femoral neck system for young patients with nonanatomically reduced femoral neck fractures: a finite element. BMC Musculoskelet Disord, 2023, 24(1): 54. doi: 10.1186/s12891-022-06124-9.
19. Stegelmann SD, Butler JT, Mathews DJ, et al. Survivability of the femoral neck system for the treatment of femoral neck fractures in adults. Eur J Orthop Surg Traumatol, 2023, 33(6): 2555-2563.
20. 葛雙雷, 王雪飛, 劉亮, 等. 股骨頸動力交叉釘系統聯合支撐空心螺釘對伴后內側粉碎的中青年股骨頸骨折的療效研究. 中華醫學雜志, 2023, 103(21): 1631-1637.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of robot-guided femoral neck system combined with cannulated compression screw fixation in treatment of femoral neck fracture in young and middle-aged patients

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