Clinical application of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAO Yanxiang ¹ , ZHAO Yanpeng ¹ , HU Lei ² , LI Zhirui ¹ , ZOU Yunpeng ² , LOU Shenghan ¹ , ZHANG Yafang ² , HAO Ming ¹ , ZHANG Hao ¹ ,  TANG Peifu ¹

1. Department of Orthopaedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China;
2. Robotics Institute, Beihang University, Beijing, 100191, P.R.China;

Corresponding?author：

TANG Peifu, Email: pftang301@163.com

Keywords：

Computer-assisted orthopedic surgery; femoral neck fracture; robot; cannulated screw; internal fixation

DOI：

10.7507/1002-1892.201611066

Video：

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Objective To investigate the clinical efficacy of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures. Methods A retrospective analysis was made on the clinical data of 20 femoral neck fracture patients treated by computer-assisted cannulated screw internal fixation system based on error correction method between January 2014 and October 2015 (trial group), and 36 femoral neck fracture patients undergoing traditional manual surgery with closed reduction by cannulated screw fixation in the same period (the control group). There was no significant difference in gender, age, injury cause, side of fracture, types of fracture, and time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion, fracture healing time, fracture healing rate, and Harris hip score were compared between 2 groups. Results All incisions healed by first intention after operation, and no complication of blood vessel and nerve injury occurred. The operation time of trial group was significantly longer than that of control group (t=2.290,P=0.026), however, the intraoperative blood loss, intraoperative frequency of fluoroscopy and guide pin insertion of trial group were significantly less than those of control group (t=–10.650,P=0.000;t=18.320,P=0.000;t=–16.625,P=0.000). All patients were followed up 12-18 months (mean, 14.7 months). X-ray films showed that fracture healing was obtained in 2 groups, showing no significant difference in fracture healing time between 2 groups (t=0.208,P=0.836). No complication of ischemic necrosis of femoral head occurred during follow-up period. At last follow-up, the Harris hip score was 87.05±3.12 in trial group and was 86.78±2.83 in control group, showing no significant difference (t=0.333,P=0.741). Conclusion Computer-assisted cannulated screw internal fixation surgery based on error correction method for femoral neck fractures is better than traditional manual surgery in decreasing intraoperative radiation and surgical trauma during operation.

Citation： CAO Yanxiang, ZHAO Yanpeng, HU Lei, LI Zhirui, ZOU Yunpeng, LOU Shenghan, ZHANG Yafang, HAO Ming, ZHANG Hao, TANG Peifu. Clinical application of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(3): 257-261. doi: 10.7507/1002-1892.201611066 Copy

1.	Wang JQ, Zhao CP, Su YG,et al. Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a Synbone hip model trial. Chin Med J (Engl), 2011, 124(23): 3906-3911.
2.	Song J, Ding H, Han W,et al. A motion compensation method for bi-plane robot-assisted internal fixation surgery of a femur neck fracture. Proc Inst Mech Eng H, 2016, 230(10): 942-948.
3.	Müller MC, Belei P, Pennekamp PH,et al. Three-dimensional computer-assisted navigation for the placement of cannulated hip screws. A pilot study. Int Orthop, 2012, 36(7): 1463-1469.
4.	Selvan VT, Oakley MJ, Rangan A,et al. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury, 2004, 35(2): 136-141.
5.	Oakey JW, Stover MD, Summers HD,et al. Does screw configuration affect subtrochanteric fracture after femoral neck fixation? Clin Orthop Relat Res, 2006, 443: 302-306.
6.	Kloen P, Rubel IF, Lyden JP,et al. Subtrochanteric fracture after cannulated screw fixation of femoral neck fractures: a report of four cases. J Orthop Trauma, 2003, 17(3): 225-229.
7.	Hamelinck HK, Haagmans M, Snoeren MM,et al. Safety of computer-assisted surgery for cannulated hip screws. Clin Orthop Relat Res, 2007, (455): 241-245.
8.	Regling M, Blau A, Probe RA,et al. Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study. BMC Musculoskelet Disord, 2014, 15: 189.
9.	劉建全, 劉黎軍, 黃俊鋒, 等. 機器人導航定位系統輔助下經皮空心螺釘內固定治療股骨頸骨折. 中華創傷骨科雜志, 2015, 17(8): 692-698.
10.	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.
11.	唐佩福, 王巖. 骨折手術學. 北京: 人民軍醫出版社, 2013: 288-313.
12.	Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res, 1980, (152): 162-172.
13.	Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury, 2016.[Epub ahead of print].
14.	胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4版. 北京: 人民軍醫出版社, 2012: 928-947.
15.	Thorngren KG, Hommel A, Norrman PO,et al. Epidemiology of femoral neck fractures. Injury, 2002, 33 Suppl 3: C1-C7.
16.	Hofstetter R, Slomczykowski M, Krettek C,et al. Computer-assisted fluoroscopy-based reduction of femoral fractures and antetorsion correction. Comput Aided Surg, 2000, 5(5): 311-325.
17.	Du H, Hu L, Li C,et al. Advancing computer-assisted orthopaedic surgery using a hexapod device for closed diaphyseal fracture reduction. Int J Med Robot, 2015, 11(3): 348-359.
18.	Westphal R, Winkelbach S, Gosling T,et al. A surgical telemanipulator for femur shaft fracture reduction. Int J Med Robot, 2006, 2(3): 238-250.
19.	Füchtmeier B, Egersdoerfer S, Mai R,et al. Reduction of femoral shaft fractures in vitro by a new developed reduction robot system ‘RepoRobo’. Injury, 2004, 35 Suppl 1: 113-119.
20.	Maeda Y, Sugano N, Saito M,et al. Robot-assisted femoral fracture reduction: preliminary study in patients and healthy volunteers. Comput Aided Surg, 2008, 13(3): 148-156.
21.	Zheng G, Nolte LP. Computer-assisted orthopedic surgery: current state and future perspective. Front Surg, 2015, 2: 66.
22.	Goradia VK. Computer-assisted and robotic surgery in orthopedics: where we are in 2014. Sports Med Arthrosc, 2014, 22(4): 202-205.
23.	Mavrogenis AF, Savvidou OD, Mimidis G,et al. Computer-assisted navigation in orthopedic surgery. Orthopedics, 2013, 36(8): 631-642.
24.	Mezger U, Jendrewski C, Bartels M. Navigation in surgery. Langenbecks Arch Surg, 2013, 398(4): 501-514.
25.	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.
26.	曾田勇. 骨科機器人導航定位系統輔助股骨頸骨折空心螺釘內固定術的應用. 中國醫療設備, 2015, 30(8): 111-113.
27.	童祎, 羅曉中, 吳剛, 等. 機器人導航下及傳統經皮空心拉力螺釘內固定術治療股骨頸骨折的療效比較. 中國修復重建外科雜志, 2016, 30(6): 685-689.
28.	吳磊, 吳京亮, 張叢笑, 等. 計算機導航輔助空心釘內固定治療無移位股骨頸骨折. 中國骨與關節損傷雜志, 2015, 30(8): 792-793.

1. Wang JQ, Zhao CP, Su YG,et al. Computer-assisted navigation systems for insertion of cannulated screws in femoral neck fractures: a comparison of bi-planar robot navigation with optoelectronic navigation in a Synbone hip model trial. Chin Med J (Engl), 2011, 124(23): 3906-3911.
2. Song J, Ding H, Han W,et al. A motion compensation method for bi-plane robot-assisted internal fixation surgery of a femur neck fracture. Proc Inst Mech Eng H, 2016, 230(10): 942-948.
3. Müller MC, Belei P, Pennekamp PH,et al. Three-dimensional computer-assisted navigation for the placement of cannulated hip screws. A pilot study. Int Orthop, 2012, 36(7): 1463-1469.
4. Selvan VT, Oakley MJ, Rangan A,et al. Optimum configuration of cannulated hip screws for the fixation of intracapsular hip fractures: a biomechanical study. Injury, 2004, 35(2): 136-141.
5. Oakey JW, Stover MD, Summers HD,et al. Does screw configuration affect subtrochanteric fracture after femoral neck fixation? Clin Orthop Relat Res, 2006, 443: 302-306.
6. Kloen P, Rubel IF, Lyden JP,et al. Subtrochanteric fracture after cannulated screw fixation of femoral neck fractures: a report of four cases. J Orthop Trauma, 2003, 17(3): 225-229.
7. Hamelinck HK, Haagmans M, Snoeren MM,et al. Safety of computer-assisted surgery for cannulated hip screws. Clin Orthop Relat Res, 2007, (455): 241-245.
8. Regling M, Blau A, Probe RA,et al. Improved lag screw positioning in the treatment of proximal femur fractures using a novel computer assisted surgery method: a cadaveric study. BMC Musculoskelet Disord, 2014, 15: 189.
9. 劉建全, 劉黎軍, 黃俊鋒, 等. 機器人導航定位系統輔助下經皮空心螺釘內固定治療股骨頸骨折. 中華創傷骨科雜志, 2015, 17(8): 692-698.
10. 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.
11. 唐佩福, 王巖. 骨折手術學. 北京: 人民軍醫出版社, 2013: 288-313.
12. Lowell JD. Results and complications of femoral neck fractures. Clin Orthop Relat Res, 1980, (152): 162-172.
13. Song HK, Choi HJ, Yang KH. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years. Injury, 2016.[Epub ahead of print].
14. 胥少汀, 葛寶豐, 徐印坎. 實用骨科學. 4版. 北京: 人民軍醫出版社, 2012: 928-947.
15. Thorngren KG, Hommel A, Norrman PO,et al. Epidemiology of femoral neck fractures. Injury, 2002, 33 Suppl 3: C1-C7.
16. Hofstetter R, Slomczykowski M, Krettek C,et al. Computer-assisted fluoroscopy-based reduction of femoral fractures and antetorsion correction. Comput Aided Surg, 2000, 5(5): 311-325.
17. Du H, Hu L, Li C,et al. Advancing computer-assisted orthopaedic surgery using a hexapod device for closed diaphyseal fracture reduction. Int J Med Robot, 2015, 11(3): 348-359.
18. Westphal R, Winkelbach S, Gosling T,et al. A surgical telemanipulator for femur shaft fracture reduction. Int J Med Robot, 2006, 2(3): 238-250.
19. Füchtmeier B, Egersdoerfer S, Mai R,et al. Reduction of femoral shaft fractures in vitro by a new developed reduction robot system ‘RepoRobo’. Injury, 2004, 35 Suppl 1: 113-119.
20. Maeda Y, Sugano N, Saito M,et al. Robot-assisted femoral fracture reduction: preliminary study in patients and healthy volunteers. Comput Aided Surg, 2008, 13(3): 148-156.
21. Zheng G, Nolte LP. Computer-assisted orthopedic surgery: current state and future perspective. Front Surg, 2015, 2: 66.
22. Goradia VK. Computer-assisted and robotic surgery in orthopedics: where we are in 2014. Sports Med Arthrosc, 2014, 22(4): 202-205.
23. Mavrogenis AF, Savvidou OD, Mimidis G,et al. Computer-assisted navigation in orthopedic surgery. Orthopedics, 2013, 36(8): 631-642.
24. Mezger U, Jendrewski C, Bartels M. Navigation in surgery. Langenbecks Arch Surg, 2013, 398(4): 501-514.
25. 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.
26. 曾田勇. 骨科機器人導航定位系統輔助股骨頸骨折空心螺釘內固定術的應用. 中國醫療設備, 2015, 30(8): 111-113.
27. 童祎, 羅曉中, 吳剛, 等. 機器人導航下及傳統經皮空心拉力螺釘內固定術治療股骨頸骨折的療效比較. 中國修復重建外科雜志, 2016, 30(6): 685-689.
28. 吳磊, 吳京亮, 張叢笑, 等. 計算機導航輔助空心釘內固定治療無移位股骨頸骨折. 中國骨與關節損傷雜志, 2015, 30(8): 792-793.

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Clinical application of computer-assisted cannulated screw internal fixation system based on error correction method for femoral neck fractures

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