Effect of robot-navigation-assisted core decompression combined with fibula grafting on early osteonecrosis of the femoral head
Objective To compare the efficacy and safety of traditional core decompression combined with fibula grafting versus robot-navigation-assisted core decompression combined with fibula grafting for hip preservation in patients with early osteonecrosis of the femoral head.Methods From January 2021 to December 2022,52 patients(52 hips)with early osteonecrosis of the femoral head were treated in Henan Provincial People's Hospital,among whom 23 patients underwent robot-navigation-assisted core decompression combined with fibula grafting(robot group),and 29 patients underwent traditional core decompression combined with fibula grafting(control group).The gender,age,body mass index,course of disease,cause of disease,Ficat stage,operative time,success rate at the first attempt of needle insertion,intraoperative blood loss and frequency of X-ray fluoroscopy were compared between two groups.Hip function was evaluated by Harris score before surgery and 12 months after surgery,and pain degree was evaluated by visual analogue scale(VAS).The complications such as postoperative infection,venous thrombosis of lower extremity,femoral neck fracture and femoral head collapse were recorded.The postoperative 1-year excellent and good rate was compared between two groups.Results(1)There were no significant differences in the gender ratio,age,body mass index,course of disease,cause of disease and Ficat stage between two groups(P＞0.05).(2)The operative time was shorter,the intraoperative blood loss volume was less,the success rate at the first attempt of needle insertion was higher,and the frequency of X-ray fluoroscopy was less in robot group[(38.17±7.39)min,(47.78±8.06)mL,100.00％,8.09± 1.35]than that in control group[(55.83±10.66)min,(71.31±8.97)mL,31.03％,13.76±2.68]respectively(t=-6.754,P＜0.001;t=-9.817,P＜0.001;x2=25.776,P＜0.001;t=-9.250,P＜0.001).(3)There were no significant differences in Harris score and VAS score between robot group[67.13±4.34,4.0(4.0,5.0)]and control group[67.38±3.59,4.0(3.5,4.0)](t=-0.226,P=0.822;U=-0.843,P=0.399)before surgery.The Harris scores in robot group and control group were higher 1 year after surgery(85.35±3.76,82.93±3.40)than those before surgery(t=-4.215,P＜0.001;t=-4.744,P＜0.001),VAS scores in robot group and control group were lower 1 year after surgery[1.0(0,1.0),1.0(0,1.0)]than those before surgery(Z=-4.290,P＜0.001;Z=-4.781,P＜0.001).The Harris score was higher in robot group than that in control group 1 year after surgery(t=2.429,P=0.019),and there was no significant difference in the VAS score between two groups(U=-0.476,P=0.634).(4)No postoperative infection,lower extremity venous thrombosis or femoral neck fracture occurred in two groups.No hip replacement occurred in two groups,and there were no femoral head collapse in robot group but 3 cases of femoral head collapse in control group 1 year after surgery.There was no significant difference in the excellent and good rate between robot group(91.30％)and control group(82.76％)(x2=0.804,P=0.370).Conclusions Core decompression combined with fibula grafting achieves a satisfactory result in the treatment of early necrosis of the femoral head.The robot navigation in the middle and downstream of the surgery can reduce the bleeding and radiation injury,shorten the operative time,improve the hip joint function,and have good safety.
osteonecrosis of the femoral headfibula graftingcore decompressionrobot navigation
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