Analysis of effectiveness of Holosight 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 909th 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 screw 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 screw 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, and 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 taken 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 the two 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 incision 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 fixators 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 screw 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.

Citation： XU Weizhen, DING Zhenqi, LIU Hui, ZHANG Jinhui, XIONG Yuanfei, WU Jin. Analysis of effectiveness of Holosight robot navigation-assisted percutaneous cannulated screw fixation in treatment of femoral neck fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(6): 673-679. doi: 10.7507/1002-1892.202502067 Copy

1.	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.
2.	張英澤. 臨床創傷骨科流行病學. 3版. 北京: 人民衛生出版社, 2018: 223-225.
3.	吳濤華, 高連云, 林臻, 等. 直接前方入路空心螺釘固定治療青壯年難復性股骨頸骨折. 中華創傷骨科雜志, 2020, 22(9): 765-770.
4.	趙德偉, 馬志杰. 創傷性股骨頸骨折后股骨頭壞死的預防. 中華顯微外科雜志, 2019, 42(1): 3-4.
5.	張子義, 覃祺, 阿里木江·玉蘇甫, 等. 青壯年PauwelsⅢ型股骨頸骨折3種內固定方案的生物力學分析. 中國組織工程研究, 2025, 29(33): 7102-7108.
6.	常廷杰, 葛宇峰, 高峰, 等. 股骨頸動力交叉釘系統與空心螺釘固定治療中青年股骨頸骨折的近期療效比較. 中華創傷骨科雜志, 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.	中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
9.	黃復銘, 張信哲, 李偉雄, 等. 機器人輔助導航與徒手經皮空心螺釘治療中青年股骨頸骨折的療效比較. 中華創傷骨科雜志, 2023, 25(11): 979-985.
10.	廖永成, 張明, 徐俊華, 等. 骨科手術機器人輔助雙平面雙支撐螺釘固定治療中青年股骨頸骨折的療效分析. 中華創傷骨科雜志, 2022, 24(12): 1069-1074.
11.	葉晶, 顏夏衛, 鄧同明, 等. 3枚空心螺釘倒品字形固定治療非移位型股骨頸骨折. 臨床骨科雜志, 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, 肖偉, 向強, 等. 股骨頸Pauwels Ⅰ型骨折空心釘內固定治療的有限元分析. 創傷外科雜志, 2024, 26(10): 739-744.
14.	仇賽, 季曉娟, 陸永剛. 3枚與4枚空心釘固定Pauwels Ⅲ型股骨頸骨折對比. 中國矯形外科雜志, 2021, 29(6): 552-555.
15.	高峰, 吳曉峰, 徐鋒, 等. 新型三維蜂窩導向器在股骨頸骨折經皮空心釘內固定中的臨床應用. 中國修復重建外科雜志, 2022, 36(1): 65-70.
16.	王思哲, 高海燕, 藍孝全, 等. 3D打印導板輔助置入空心釘治療無移位型股骨頸骨折的短期評價. 中國組織工程研究, 2021, 25(36): 5753-5758.
17.	任步方, 呂欣, 馬全平, 等. 新型導向器用于空心釘內固定治療股骨頸骨折的療效分析. 中華創傷骨科雜志, 2022, 24(4): 328-333.
18.	鄭育耿, 馬洪, 李留陽, 等. 機器人手術系統輔助閉合復位內固定術治療兒童Delbet Ⅱ型及Ⅲ型股骨頸骨折. 臨床小兒外科雜志, 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.	劉剛, 毛玉江, 楊明輝, 等. 骨科機器人輔助股骨近端外展截骨動力髖螺釘固定治療中青年股骨頸骨折不愈合的臨床療效分析. 中華解剖與臨床雜志, 2023, 28(1): 14-20.
26.	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.
2. 張英澤. 臨床創傷骨科流行病學. 3版. 北京: 人民衛生出版社, 2018: 223-225.
3. 吳濤華, 高連云, 林臻, 等. 直接前方入路空心螺釘固定治療青壯年難復性股骨頸骨折. 中華創傷骨科雜志, 2020, 22(9): 765-770.
4. 趙德偉, 馬志杰. 創傷性股骨頸骨折后股骨頭壞死的預防. 中華顯微外科雜志, 2019, 42(1): 3-4.
5. 張子義, 覃祺, 阿里木江·玉蘇甫, 等. 青壯年PauwelsⅢ型股骨頸骨折3種內固定方案的生物力學分析. 中國組織工程研究, 2025, 29(33): 7102-7108.
6. 常廷杰, 葛宇峰, 高峰, 等. 股骨頸動力交叉釘系統與空心螺釘固定治療中青年股骨頸骨折的近期療效比較. 中華創傷骨科雜志, 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. 中華醫學會骨科學分會創傷骨科學組, 中國醫師協會骨科醫師分會創傷專家工作委員會. 成人股骨頸骨折診治指南. 中華創傷骨科雜志, 2018, 20(11): 921-928.
9. 黃復銘, 張信哲, 李偉雄, 等. 機器人輔助導航與徒手經皮空心螺釘治療中青年股骨頸骨折的療效比較. 中華創傷骨科雜志, 2023, 25(11): 979-985.
10. 廖永成, 張明, 徐俊華, 等. 骨科手術機器人輔助雙平面雙支撐螺釘固定治療中青年股骨頸骨折的療效分析. 中華創傷骨科雜志, 2022, 24(12): 1069-1074.
11. 葉晶, 顏夏衛, 鄧同明, 等. 3枚空心螺釘倒品字形固定治療非移位型股骨頸骨折. 臨床骨科雜志, 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, 肖偉, 向強, 等. 股骨頸Pauwels Ⅰ型骨折空心釘內固定治療的有限元分析. 創傷外科雜志, 2024, 26(10): 739-744.
14. 仇賽, 季曉娟, 陸永剛. 3枚與4枚空心釘固定Pauwels Ⅲ型股骨頸骨折對比. 中國矯形外科雜志, 2021, 29(6): 552-555.
15. 高峰, 吳曉峰, 徐鋒, 等. 新型三維蜂窩導向器在股骨頸骨折經皮空心釘內固定中的臨床應用. 中國修復重建外科雜志, 2022, 36(1): 65-70.
16. 王思哲, 高海燕, 藍孝全, 等. 3D打印導板輔助置入空心釘治療無移位型股骨頸骨折的短期評價. 中國組織工程研究, 2021, 25(36): 5753-5758.
17. 任步方, 呂欣, 馬全平, 等. 新型導向器用于空心釘內固定治療股骨頸骨折的療效分析. 中華創傷骨科雜志, 2022, 24(4): 328-333.
18. 鄭育耿, 馬洪, 李留陽, 等. 機器人手術系統輔助閉合復位內固定術治療兒童Delbet Ⅱ型及Ⅲ型股骨頸骨折. 臨床小兒外科雜志, 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. 劉剛, 毛玉江, 楊明輝, 等. 骨科機器人輔助股骨近端外展截骨動力髖螺釘固定治療中青年股骨頸骨折不愈合的臨床療效分析. 中華解剖與臨床雜志, 2023, 28(1): 14-20.
26. 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

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

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