探讨基于髋关节置换机器人辅助手术系统的智能术前规划在高龄股骨颈骨折行人工股骨头置换患者人群术中的临床意义。

回顾性分析西安交通大学第二附属医院骨科自2019年10月至2022年2月完成的创伤后单侧股骨颈骨折行人工股骨头置换患者资料，排除病理性骨折、骨折时间大于4周及严重骨质疏松的病例。所有患者均由同一组手术医生经后外侧入路行人工股骨头置换术，均使用同一种生物固定型假体。收集患者年龄、性别、身体质量指数(BMI)、手术时间、术中出血量、是否进行术前规划，术前规划股骨柄假体型号及术中实际使用股骨柄假体型号等，在手术记录中以及术后X片中明确是否发生术中假体周围骨折，以及假体周围骨折类型等资料。按照是否进行术前规划将所有患者分为两组，利用独立样本t检验，卡方检验比较两组之间的基线资料、手术时间、术中出血量及术中假体周围骨折发生率等。

共纳入186例患者，其中男性59例，女性127例，年龄(84±4)岁；BMI(23±4)kg/m²；手术时间(44±7)min；术中出血量(265±45)ml。有62例患者于术前进行规划，其中56例患者按照术前规划股骨柄型号成功植入股骨柄假体，6例患者术中实际植入假体与术前规划型号不符。186例患者中，发生术中假体周围骨折患者9例，其中术前规划组有1例发生假体周围骨折，非术前规划组有8例发生假体周围骨折。术前规划组的手术时间、手术出血量均低于非规划组(t＝10.153、11.412，均为P<0.05)；术前规划组术中假体周围骨折发生率低于非规划组(1.6% vs.6.5%)，但差异无统计学意义(P＝0.227)。

基于机器人辅助系统的术前规划可以有效降低手术时间及术中出血量，是否能降低术中假体周围骨折的发生率还需要更大样本的研究。

To explore the clinical significance of intelligent preoperative planning based on the hip replacement robot-assisted system in the population of elderly patients undergoing artificial femoral head replacement for femoral neck fractures.

The data of the patients who accepted artificial femoral head replacement for unilateral femoral neck fracture from October 2019 to February 2022 in the Department of Bone and Joint, the Second Affiliated Hospital of Xi′an Jiaotong University were retrospectively analyzed. Pathological fractures, the fracture time longer than four weeks and severe osteoporosis were exluded. All the patients received the surgery with a posterolateral approach by the same group of surgeons using the same biological fixation prosthesis. Age, gender, body mass index (BMI), operation time, intraoperative blood loss, whether conducting preoperative planning or not, the size of preoperative planning and actual use of femoral stem prosthesis were recorded; the intraoperative periprosthesis fracture was determined according to the surgical records and postoperative X-ray. The types of fracture were determined by Vancouver classification. The patients were divided into two groups based on whether or not preoperative planning was performed; the baseline data, duration of surgery, intraoperative blood loss, and incidence of intraoperative periprosthetic fractures were compared between the two groups using independent samples t test and chi square test.

A total of 186 patients were included in this study, including 59 males and 127 females. The age was(84±4) years, average BMI was(23±4)kg/m^2, the operation time was(44±7)min, and the intraoperative blood loss was(265±45)ml. Sixty-two patients adopted preoperative planning before the surgery, and the femoral stem prostheses were successfully implanted according to the planned femoral stem models in 56 patients, while the actual implant models in six patients were inconsistent with the planned femoral stem models. Among the 186 patients, nine had periprosthesis fractures during the operation, one in the preoperative planning group and eight in the non-preoperative planning group. The operative time and the blood loss were less in the planned group than in the unplanned group (t=10.153, 11.412, both P<0.05). The incidence of intraoperative periprosthesis fractures in the planned group was lower than that in the unplanned group (1.6% vs.6.5%), but the difference was not statistically significant(P=0.227).

Preoperative planning based on robot-assisted system can effectively reduce operative time and intraoperative blood loss, and whether it can reduce the incidence of intraoperative periprosthesis fracture needs to be studied in a larger sample.