Abstract
ObjectiveTo investigate the safety and superiority of robot‐assisted femoral head drilling decompression in the treatment of femoral head necrosis.MethodsA total of 63 patients who underwent borehole decompression of the femoral head in our hospital from January 2016 to March 2019 were recruited. Patients were divided into two groups for comparison according to surgical methods. In the robot‐assisted surgery group, there were 30 cases with 41 femoral heads. The conventional group had 33 cases and 46 femoral heads. All patients signed the consent form before the operation. The follow‐up time was 6 months. The incision lengths, operation times, intraoperative blood loss, intraoperative fluoroscopies, guide needle punctures, postoperative Harris scores, and postoperative complications of the two groups were compared.ResultsThe incision length of the robot surgery group was 5.16 ± 0.41 cm, while that of the traditional surgery group was 7.42 ± 0.50 cm. The operation time of the robot surgery group was 46.99 ± 4.94 min, while that of the traditional surgery group was 55.01 ± 6.19 min. The fluoroscopy frequency of the robot surgery group was 10.50 ± 1.78 times, while that of the traditional surgery group was 17.91 ± 2.20 times. The intraoperative blood loss in the robotic surgery group was 20.62 ± 2.52 mL, while that in the conventional surgery group was 52.72 ± 3.39 mL. In the robot operation group, each femoral head guide needle was punctured three times, and the puncture was successful one time. The number of guided needle punctures in the traditional group was 8.02 ± 1.73. The difference between the two groups was statistically significant (P < 0.05). The Harris score was 69.53 ± 7.51 in the robot surgery group and 68.38 ± 7.26 in the traditional surgery group one month after surgery, 78.52 ± 6.49 in the robot surgery group and 76.41 ± 7.95 in the traditional surgery group three months after surgery, and 83.32 ± 8.62 in the robot surgery group and 81.74 ± 6.20 in the traditional surgery group six months after surgery. There was no significant difference between the two groups (P > 0.05). In the traditional group, there was one case of incision infection and one case of femoral head collapse during follow‐up. In the robot group, there were no complications, such as incision infection and deep vein thrombosis. No collapse of the femoral head was found in the robot group during follow‐up.ConclusionThe positioning system of the orthopaedic robot is an ideal method for the treatment of femoral head necrosis. This method has the advantages of simple operation, accurate drilling, a short operation time, less surgical trauma, less radioactivity, and good recovery of hip joint function.
Highlights
O steonecrosis of the avascular necrosis femoral head (ONFH) and aseptic necrosis
The imbalance of the bone formation system can be further manifested as sparsity, fracture, and microfracture of trabecular bone
According to the operation instructions of the TiRobot orthopaedic robot system, the robot system was installed and debugged by referring to the method of drilling and decompressing the femoral head assisted by the robot navigation and positioning system
Summary
O steonecrosis of the avascular necrosis femoral head (ONFH) and aseptic necrosis. It is is called a common disease in orthopaedics[1,2] that has a high disability rate and lacks effective treatment in clinical practice[3]. HAS THE ADVANTAGES OF SMALL TRAUMA AND HIGHSAFETY into two categories: traumatic and non-traumatic[4]. The main causes of nontraumatic femoral head necrosis in China are corticosteroid application, alcohol abuse, decompression sickness, sickle cell anaemia, and idiopathic type[5,6]. The most common causes are glucocorticoids, alcohol, and trauma. The density of functional microvessels in the subchondral bone of the diseased femoral head decreases, the vascular permeability is abnormal, and the angiogenesis ability becomes poor. Bone formation-related apoptosis of the diseased femoral head increases, and progenitor cell proliferation and osteogenic differentiation are decreased. There is hypertrophy of adipocytes along with infiltration of inflammatory cells in the diseased femoral head. The dissection of cartilage and subchondral bone can be observed by gross pathology. The vascular lesions and imbalanced bone formation in ONFH affect each other[7–9]
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