Effect of robot-assisted core decompression and bone grafting fornecrosis of femoral head

doi:10.3877/cma.j.issn.1674-134X.2023.01.018

Abstract

Abstract:

Objective

To observe the effect of the domestic orthopedic robot-assisted core decompression and bone grafting surgery for early necrosis of the femoral head.

Methods

A retrospective analysis was performed on 36 cases underwent core decompression and bone grafting for early necrosis of the femoral head treated at Department of Bone and Joint Surgery, the Second Affiliated Hospital of Xi ′an Jiaotong University from June 2020 to May 2021. 15 cases underwent robot-assisted surgery, and 21 cases underwent conventional surgery. All the patients were in Association research circulation osseous (ARCO)stageⅡ. The operating times, the number of guidewire attempts and total number of intraoperative radiation exposure were recorded. The preoperative and postoperative Harris scores and VAS scores in three and six months were compared. The repeated measurements analysis of variances and t test of two independent samples were used for statistical analysis.

Results

All the patients were successfully followed up, and the operation time of the robot-assisted group (57.3±18.9) min was significantly shorter than that of the traditional group (71.6±18.2) min (t=2.292, P<0.05); compared with the traditional group, the number of guidewire attempts, the total number of intraoperative radiation exposure, and the number of radiation exposure during insertion of guidewire were significantly reduced in the robot-assisted group (t=6.818, 4.871, 4.546, all P<0.05), and there were no significant differences between the two groups in Harris score and VAS score at three and six months postoperatively (F=0.080, 0.069, both P>0.05).

Conclusion

It is safe and effective to use the domestic robot-assisted core decompression and bone grafting for the treatment of early femoral head necrosis, which can save the operation time and reduce the radiation exposure.

Key words: Femur head necrosis, Bone transplantation, Robotic surgical procedures

Rui Ma, Pei Yang, Run Tian, Chunsheng Wang, Kunzheng Wang. Effect of robot-assisted core decompression and bone grafting fornecrosis of femoral head[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 123-128.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2023.01.018

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2023/V17/I01/123

Figures/Tables 7

Figure 1 Preoperative software planning for the robot-assisted group

Figure 2 The process of guidewire insertion in the robot-assisted group. A is positioning, and the small figure in the upper-right corner is the perspective figure; B is multimodal fusion, and the small figure in the upper-right corner is the schematic diagram of the bone tunnel in the robot-assisted group; C is guidewire insertion; D is the perspective figure of the right hip in the anteroposterior position after successful placement of the guidewire, and the small figure in the upper-right corner is the frog-like perspective figure of the right hip

Figure 3 Photos of the instruments used in the core decompression and bone grafting surgery. A is the reamer for core decompression; B is the funnel sleeve for bone grafting

Table 1 General data and intraoperative indicators of the patients

组别Group	例数Case number	年龄Age[岁，(±s)]	性别Gender(男/女)(male/female)	病程Course[个月，(±s)]	手术时间Operation time[min，(±s)]	尝试穿刺次数Number of guidewire attempts(±s)	总透线次数Number of intraoperative radiation exposure(±s)	置入导针透线次数Number of radiation exposure during guidewire insertion (±s)	减压植骨透线次数Number of radiation exposure during decompression(±s)
机器人组Robot group	15	47.7±8.9	9/6	6.0±6.4	57.3±18.9	3.0±1.2	16.1±1.7	6.1±1.6	10.1±1.3
传统组Traditional group	21	44.0±10.8	10/11	7.5±6.2	71.6±18.2	6.7±1.8	22.1±5.2	10.2±3.8	11.2±2.6
统计值		t＝1.097	－	t＝0.725	t＝2.292	t＝6.818	t＝4.871	t＝4.546	t＝1.711
P值		>0.05	0.516^*	>0.05	0.028	<0.001	<0.001	<0.001	>0.05

Table 2 The Harris scores of the two groups before and after treatment

组别Group	例数Case number	术前Pre-operation	术后3个月Three months after operation	术后6个月Six months after operation	F值	P值
机器人组Robot group	15	57±11	77±9	88±6	219.472	<0.001
传统组Traditional group	21	59±12	76±10	87±8
F值			0.080
P值			>0.05

Table 3 The VAS scores of the two groups before and after treatment

组别Group	例数Case number	术前Pre-operation	术后3个月Three months after operation	术后6个月Six months after operation	F值	P值
机器人组Robot group	15	5.2±0.9	2.0±1.1	1.1±0.8	273.261	<0.001
传统组Traditional group	21	5.1±1.3	2.0±1.0	1.4±0.9
F值			0.069
P值			>0.05

Figure 4 X rays of typical case(anteroposterior radiographs of both hips, necrosis of the right femoral head). A is the preoperative photo that shows the necrotic lesion is located in the right femoral head; B is the postoperative photo after three months that showed the right bone tunnel reached the necrotic lesion accurately and the bone grafting is satisfactory; C is the postoperative photo after six months that showed good healing of the right femoral head lesion

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