Objective: The incidence of hip fracture in the elderly is increasing. Robot navigation technology has the advantages of minimally invasive and accurate. To explore the difference between the clinical effects of proximal femoral anti-rotation intramedullary nail (PFNA) assisted by robot navigation in the treatment of femoral intertrochanteric fracture and traditional PFNA in the treatment of femoral intertrochanteric fracture in the elderly; analyze the advantages and feasibility of PFNA assisted by robot navigation in the treatment of femoral intertrochanteric fracture in the elderly.
Patients and Methods: From February 2021 to October 2022, the elderly (> 65 years old) with femoral intertrochanteric fracture underwent surgery in our center. Divided the patients included in the study into 2 groups based on the surgical method. The surgical method of robot group was PFNA fixation assisted by robot navigation, while the surgical method of traditional group was classic PFNA fixation, Baseline data (general condition, Evans classification, time from injury to operation, preoperative hemoglobin) and observation indicators (intraoperative bleeding, operation time, the length of incision for mail nail insertion, postoperative hemoglobin drop, blood transfusion rate and the Harris score of hip joint 1 year after operation) of the two groups were collected to compare whether there were differences between the two groups.
Results: There was no statistical difference in baseline data between the two groups (P> 0.05). The intraoperative bleeding in the robot group was 68.17± 10.66 mL, the intraoperative bleeding in the traditional group was 174± 8.11mL (P< 0.001). The operation time in the robot group was 68.81 ± 6.89 min, in the traditional group, the operation time was 76.94 ± 8.18 min (P< 0.001). The length of incision for mail nail insertion in the robot group was 3.53 ± 0.63 cm, the length of the incision for mail nail insertion in the traditional group was 4.23 ± 0.71 cm (P< 0.001). 5 patients (13.9%) in the robot group received blood transfusion treatment, and 13 patients (36.1%) in the traditional group received blood transfusion treatment (P=0.029). The hemoglobin in the robot group decreased by 14.81 ± 3.27 g/l after operation compared with that before operation, while that in the traditional group decreased by 16.69 ± 3.32 g/l (P=0.018). The Harris score of the hip joint of the affected limb in the robot group was excellent in 25 cases, good in 8 cases and poor in 3 cases one year after the operation; In the traditional group, Harris scores were excellent in 18 cases, good in 11 cases and poor in 7 cases (P=0.021).
Conclusion: PFNA fixation of femoral intertrochanteric fracture with robot navigation assistance has the advantages of minimally invasive and accurate, shorter operation time, less bleeding and lower blood transfusion rate than traditional surgical methods, and has certain advantages in reducing postoperative complications of elderly patients.

Keywords: orthopedics robot navigation, femoral fracture, older persons, intramedullary nail fixation


中文翻译：

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机器人导航系统辅助PFNA固定老年股骨粗隆间骨折的回顾性临床研究

目的：老年人髋部骨折的发生率呈上升趋势。机器人导航技术具有微创、精准的优点。探讨机器人导航辅助下股骨近端防旋髓内钉（PFNA）治疗股骨粗隆间骨折与传统PFNA治疗老年股骨粗隆间骨折的临床效果差异；分析机器人导航辅助PFNA治疗老年股骨粗隆间骨折的优势及可行性。
患者及方法： 2021年2月至2022年10月，老年股骨粗隆间骨折患者（>65岁）在我中心接受手术治疗。根据手术方法将研究中的患者分为 2 组。机器人组手术方式为机器人导航辅助PFNA固定，传统组手术方式为经典PFNA固定，基线资料（一般情况、Evans分型、受伤至手术时间、术前血红蛋白）及观察指标（术中出血）收集两组患者的手术时间、置钉切口长度、术后血红蛋白下降情况、输血率以及术后1年髋关节Harris评分），比较两组之间是否存在差异。
结果：两组基线资料比较，差异无统计学意义（P>0.05）。机器人组术中出血量为68.17±10.66 mL，传统组术中出血量为174±8.11 mL（P<0.001）。机器人组手术时间为68.81±6.89 min，传统组手术时间为76.94±8.18 min（P<0.001）。机器人组置钉切口长度为3.53±0.63 cm，传统组置钉切口长度为4.23±0.71 cm（P<0.001）。机器人组5例患者（13.9%）接受输血治疗，传统组13例患者（36.1%）接受输血治疗（P=0.029）。机器人组术后血红蛋白较术前下降14.81±3.27 g/l，传统组下降16.69±3.32 g/l（P=0.018）。术后1年机器人组患肢髋关节Harris评分优25例，良8例，差3例；传统组Harris评分优18例，良11例，差7例（P=0.021）。
结论：机器人导航辅助PFNA固定股骨粗隆间骨折较传统手术方法具有微创准确、手术时间短、出血少、输血率低等优点，在减少老年患者术后并发症方面具有一定优势。

关键词:骨科机器人导航, 股骨骨折, 老年人, 髓内钉内固定