Analysis of effectiveness of Holosight orthopedic robot navigation-assisted percutaneous cannulated screw fixation in treatment of femoral neck fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Weizhen , DING Zhenqi , LIU Hui , ZHANG Jinhui , XIONG Yuanfei ,  WU Jin

Department of Orthopedics, the 909 Hospital, Dongnan Hospital of Xiamen University, Zhangzhou Fujian, 363000, P. R. China;

Corresponding author：

WU Jin, Email: wujin1983@xmu.edu.cn

Keywords：

Femoral neck fracture; percutaneous nail placement; cannulated screw fixation; Holosight robot

DOI：

10.7507/1002-1892.202502067

Video：

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Objective To investigate the effectiveness of Holosight robotic navigation-assisted percutaneous cannulated screw fixation for femoral neck fractures. Methods A retrospective analysis was conducted on 65 patients with femoral neck fractures treated with cannulated screw fixation between January 2022 and February 2024. Among them, 31 patients underwent robotic navigation-assisted screw placement (navigation group), while 34 underwent conventional freehand percutaneous fixation (freehand group). Baseline characteristics, including age, gender, fracture side, injury mechanism, Garden classification, Pauwels classification, and time from injury to operation, showed no significant differences between the two groups (P>0.05). The operation time, intraoperative blood loss, fluoroscopy frequency, fracture healing time, complications were recorded and compared, and hip function was evaluated by Harris score at last follow-up. Postoperative anteroposterior and lateral hip X-ray films were analyzed to assess screw distribution accuracy, including deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex. Results No significant difference was observed in operation time between groups (P>0.05). However, the navigation group demonstrated superior outcomes in intraoperative blood loss, fluoroscopy frequency, deviation from the femoral neck axis, inter-screw parallelism, and distance from screws to the femoral neck cortex (P<0.05). No incisional infections or deep vein thrombosis occurred. All patients were followed up 12-18 months (mean, 16 months). In the freehand group, 1 case suffered from cannulated screw dislodgement and nonunion secondary to osteonecrosis of femoral head at 1 year after operation, 1 case suffered from screw penetration secondary to osteonecrosis of femoral head at 5 months after operation; and 1 case suffered from nonunion secondary to osteonecrosis of femoral head at 6 months after operation in the navigation group. All the 3 patients underwent internal fixation removal and total hip arthroplasty. There was no significant difference in the incidence of complications between the two groups (P>0.05). The fracture healing time and hip Harris score at last follow-up in the navigation group were significantly better than those in the freehand group (P<0.05). Conclusion Compared to freehand percutaneous fixation, Holosight robotic navigation-assisted cannulated screw fixation for femoral neck fractures achieves higher precision, reduced intraoperative radiation exposure, smaller incisions, and superior postoperative hip function recovery.

1.	葛双雷, 王雪飞, 刘亮, 等. 股骨颈动力交叉钉系统联合支撑空心螺钉对伴后内侧粉碎的中青年股骨颈骨折的疗效研究. 中华医学杂志, 2023, 103(21): 1631-1637.
2.	张英泽. 临床创伤骨科流行病学. 3版. 北京: 人民卫生出版社, 2018: 223-225.
3.	吴涛华, 高连云, 林臻, 等. 直接前方入路空心螺钉固定治疗青壮年难复性股骨颈骨折. 中华创伤骨科杂志, 2020, 22(9): 765-770.
4.	赵德伟, 马志杰. 创伤性股骨颈骨折后股骨头坏死的预防. 中华显微外科杂志, 2019, 42(1): 3-4.
5.	张子义, 覃祺, 阿里木江·玉苏甫, 等. 青壮年PauwelsⅢ型股骨颈骨折3种内固定方案的生物力学分析. 中国组织工程研究, 2025, 29(33): 7102-7108.
6.	常廷杰, 葛宇峰, 高峰, 等. 股骨颈动力交叉钉系统与空心螺钉固定治疗中青年股骨颈骨折的近期疗效比较. 中华创伤骨科杂志, 2022, 24(6): 533-537.
7.	Wu XB, Wang JQ, Sun X, et al. Guidance for the treatment of femoral neck fracture with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg, 2019, 11(3): 335-340.
8.	中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
9.	黄复铭, 张信哲, 李伟雄, 等. 机器人辅助导航与徒手经皮空心螺钉治疗中青年股骨颈骨折的疗效比较. 中华创伤骨科杂志, 2023, 25(11): 979-985.
10.	廖永成, 张明, 徐俊华, 等. 骨科手术机器人辅助双平面双支撑螺钉固定治疗中青年股骨颈骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(12): 1069-1074.
11.	叶晶, 颜夏卫, 邓同明, 等. 3枚空心螺钉倒品字形固定治疗非移位型股骨颈骨折. 临床骨科杂志, 2024, 27(4): 574.
12.	Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
13.	朱浩然, 肖伟, 向强, 等. 股骨颈Pauwels Ⅰ型骨折空心钉内固定治疗的有限元分析. 创伤外科杂志, 2024, 26(10): 739-744.
14.	仇赛, 季晓娟, 陆永刚. 3枚与4枚空心钉固定Pauwels Ⅲ型股骨颈骨折对比. 中国矫形外科杂志, 2021, 29(6): 552-555.
15.	高峰, 吴晓峰, 徐锋, 等. 新型三维蜂窝导向器在股骨颈骨折经皮空心钉内固定中的临床应用. 中国修复重建外科杂志, 2022, 36(1): 65-70.
16.	王思哲, 高海燕, 蓝孝全, 等. 3D打印导板辅助置入空心钉治疗无移位型股骨颈骨折的短期评价. 中国组织工程研究, 2021, 25(36): 5753-5758.
17.	任步方, 吕欣, 马全平, 等. 新型导向器用于空心钉内固定治疗股骨颈骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(4): 328-333.
18.	郑育耿, 马洪, 李留阳, 等. 机器人手术系统辅助闭合复位内固定术治疗儿童Delbet Ⅱ型及Ⅲ型股骨颈骨折. 临床小儿外科杂志, 2023, 22(12): 1164-1169.
19.	Mei J, Liu S, Jia G, et al. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation. Injury, 2014, 45(12): 2045-2050.
20.	Yuan BJ, Shamaa MT, Aibinder WR, et al. High incidence of “in-out-in” posterosuperior screws after cannulated screw fixation of femoral neck fractures. Eur J Orthop Surg Traumatol, 2020, 30(8): 1417-1420.
21.	Trikha V, Kumar A, Mittal S, et al. Risk of bony violation with standard triple screw configurations for fixation of femoral neck fractures: A preliminary computed tomography based analysis. J Clin Orthop Trauma, 2020, 11(Suppl 4): S546-S552.
22.	Hoffmann JC, Kellam J, Kumaravel M, et al. Is the cranial and posterior screw of the “inverted triangle” configuration for femoral neck fractures safe? J Orthop Trauma, 2019, 33(7): 331-334.
23.	Liu HS, Duan SJ, Liu SD, et al. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures. Int J Med Robot, 2018, 14(5): e1927. doi: 10.1002/rcs.1927.
24.	Thakkar SC, Thakkar RS, Sirisreetreerux N, et al. 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology. Int J Comput Assist Radiol Surg, 2017, 12(1): 69-76.
25.	黄复铭, 张信哲, 李伟雄, 等. 机器人辅助导航与徒手经皮空心螺钉治疗中青年股骨颈骨折的疗效比较. 中华创伤骨科杂志, 2023, 25(11): 979-985.
26.	刘刚, 毛玉江, 杨明辉, 等. 骨科机器人辅助股骨近端外展截骨动力髋螺钉固定治疗中青年股骨颈骨折不愈合的临床疗效分析. 中华解剖与临床杂志, 2023, 28(1): 14-20.
27.	Duan SJ, Liu HS, Wu WC, et al. Robot-assisted percutaneous cannulated screw fixation of femoral neck fractures: Preliminary clinical results. Orthop Surg, 2019, 11(1): 34-41.

1. 葛双雷, 王雪飞, 刘亮, 等. 股骨颈动力交叉钉系统联合支撑空心螺钉对伴后内侧粉碎的中青年股骨颈骨折的疗效研究. 中华医学杂志, 2023, 103(21): 1631-1637.
2. 张英泽. 临床创伤骨科流行病学. 3版. 北京: 人民卫生出版社, 2018: 223-225.
3. 吴涛华, 高连云, 林臻, 等. 直接前方入路空心螺钉固定治疗青壮年难复性股骨颈骨折. 中华创伤骨科杂志, 2020, 22(9): 765-770.
4. 赵德伟, 马志杰. 创伤性股骨颈骨折后股骨头坏死的预防. 中华显微外科杂志, 2019, 42(1): 3-4.
5. 张子义, 覃祺, 阿里木江·玉苏甫, 等. 青壮年PauwelsⅢ型股骨颈骨折3种内固定方案的生物力学分析. 中国组织工程研究, 2025, 29(33): 7102-7108.
6. 常廷杰, 葛宇峰, 高峰, 等. 股骨颈动力交叉钉系统与空心螺钉固定治疗中青年股骨颈骨折的近期疗效比较. 中华创伤骨科杂志, 2022, 24(6): 533-537.
7. Wu XB, Wang JQ, Sun X, et al. Guidance for the treatment of femoral neck fracture with precise minimally invasive internal fixation based on the orthopaedic surgery robot positioning system. Orthop Surg, 2019, 11(3): 335-340.
8. 中华医学会骨科学分会创伤骨科学组, 中国医师协会骨科医师分会创伤专家工作委员会. 成人股骨颈骨折诊治指南. 中华创伤骨科杂志, 2018, 20(11): 921-928.
9. 黄复铭, 张信哲, 李伟雄, 等. 机器人辅助导航与徒手经皮空心螺钉治疗中青年股骨颈骨折的疗效比较. 中华创伤骨科杂志, 2023, 25(11): 979-985.
10. 廖永成, 张明, 徐俊华, 等. 骨科手术机器人辅助双平面双支撑螺钉固定治疗中青年股骨颈骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(12): 1069-1074.
11. 叶晶, 颜夏卫, 邓同明, 等. 3枚空心螺钉倒品字形固定治疗非移位型股骨颈骨折. 临床骨科杂志, 2024, 27(4): 574.
12. Medda S, Snoap T, Carroll EA. Treatment of young femoral neck fractures. J Orthop Trauma, 2019, 33 Suppl 1: S1-S6.
13. 朱浩然, 肖伟, 向强, 等. 股骨颈Pauwels Ⅰ型骨折空心钉内固定治疗的有限元分析. 创伤外科杂志, 2024, 26(10): 739-744.
14. 仇赛, 季晓娟, 陆永刚. 3枚与4枚空心钉固定Pauwels Ⅲ型股骨颈骨折对比. 中国矫形外科杂志, 2021, 29(6): 552-555.
15. 高峰, 吴晓峰, 徐锋, 等. 新型三维蜂窝导向器在股骨颈骨折经皮空心钉内固定中的临床应用. 中国修复重建外科杂志, 2022, 36(1): 65-70.
16. 王思哲, 高海燕, 蓝孝全, 等. 3D打印导板辅助置入空心钉治疗无移位型股骨颈骨折的短期评价. 中国组织工程研究, 2021, 25(36): 5753-5758.
17. 任步方, 吕欣, 马全平, 等. 新型导向器用于空心钉内固定治疗股骨颈骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(4): 328-333.
18. 郑育耿, 马洪, 李留阳, 等. 机器人手术系统辅助闭合复位内固定术治疗儿童Delbet Ⅱ型及Ⅲ型股骨颈骨折. 临床小儿外科杂志, 2023, 22(12): 1164-1169.
19. Mei J, Liu S, Jia G, et al. Finite element analysis of the effect of cannulated screw placement and drilling frequency on femoral neck fracture fixation. Injury, 2014, 45(12): 2045-2050.
20. Yuan BJ, Shamaa MT, Aibinder WR, et al. High incidence of “in-out-in” posterosuperior screws after cannulated screw fixation of femoral neck fractures. Eur J Orthop Surg Traumatol, 2020, 30(8): 1417-1420.
21. Trikha V, Kumar A, Mittal S, et al. Risk of bony violation with standard triple screw configurations for fixation of femoral neck fractures: A preliminary computed tomography based analysis. J Clin Orthop Trauma, 2020, 11(Suppl 4): S546-S552.
22. Hoffmann JC, Kellam J, Kumaravel M, et al. Is the cranial and posterior screw of the “inverted triangle” configuration for femoral neck fractures safe? J Orthop Trauma, 2019, 33(7): 331-334.
23. Liu HS, Duan SJ, Liu SD, et al. Robot-assisted percutaneous screw placement combined with pelvic internal fixator for minimally invasive treatment of unstable pelvic ring fractures. Int J Med Robot, 2018, 14(5): e1927. doi: 10.1002/rcs.1927.
24. Thakkar SC, Thakkar RS, Sirisreetreerux N, et al. 2D versus 3D fluoroscopy-based navigation in posterior pelvic fixation: review of the literature on current technology. Int J Comput Assist Radiol Surg, 2017, 12(1): 69-76.
25. 黄复铭, 张信哲, 李伟雄, 等. 机器人辅助导航与徒手经皮空心螺钉治疗中青年股骨颈骨折的疗效比较. 中华创伤骨科杂志, 2023, 25(11): 979-985.
26. 刘刚, 毛玉江, 杨明辉, 等. 骨科机器人辅助股骨近端外展截骨动力髋螺钉固定治疗中青年股骨颈骨折不愈合的临床疗效分析. 中华解剖与临床杂志, 2023, 28(1): 14-20.
27. Duan SJ, Liu HS, Wu WC, et al. Robot-assisted percutaneous cannulated screw fixation of femoral neck fractures: Preliminary clinical results. Orthop Surg, 2019, 11(1): 34-41.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesAnalysis of effectiveness of Holosight orthopedic robot navigation-assisted percutaneous cannulated screw fixation in treatment of femoral neck fractures

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