Abstract: OBJECTIVE: At present, the hollow screw internal fixation of femoral neck fracture mainly depends on the bare-handed placement of screws by clinicians under fluoroscopic monitoring. Due to the different experience of each doctor and the instability of manual operation, it is difficult to ensure that each screw can obtain a satisfactory position. At the same time, repeated fluoroscopy increases radiation damage to medical staff and patients. This paper compares the clinical efficacy of robot-assisted and traditional manual hollow nail internal fixation in the treatment of femoral neck fracture.
METHODS: A computer was used to retrieve the PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases. The retrieval time was from the inception of the database to July 2020. To search the literature at home and abroad on the comparative study of the efficacy of robot-assisted and traditional hand-implanted hollow nail internal fixation in the treatment of femoral neck fracture. Two researchers independently screened the literature according to the inclusion and exclusion criteria, extracted data, and strictly evaluated the quality of the included literature. Meta-analysis was performed with RevMan 5.3 software, including operation time, intraoperative blood loss, functional score, fracture healing time and complications.
RESULTS: (1) Through literature retrieval and according to inclusion and exclusion criteria, eight retrospective cohort studies were included in the study. (2) A total of 659 patients were included in the robot assisted group (n=315) and traditional operation group (n=344). (3) The results of meta-analysis showed that in the robot assisted group, the operation time (MD=-8.71, 95%CI:-12.08 to -5.34), the amount of intraoperative blood loss (MD=-18.17, 95%CI:-27.55 to -8.80), the number of intraoperative fluoroscopy (MD=-20.86, 95%CI:-31.68 to -10.04), the number of intraoperative guide needle drilling (MD=-9.64, 95%CI:-13.23 to -6.06), and the final follow-up hip Harris score (MD=2.87, 95%CI:0.56 to 5.18) were significantly better than those in the traditional operation group (P < 0.05). There may be a significant difference in the fracture healing time (MD=-0.24, 95%CI:-0.47 to -0.000) between the two groups (P=0.05). There was no significant difference in the excellent and good rate (OR=2.25, 95%CI:0.88-5.73), screw loosening rate (OR=0.19, 95%CI:0.02-1.59), and fracture healing rate (OR=2.41, 95%CI:0.68-8.52) between the two groups (P > 0.05).
CONCLUSION: The use of robot-assisted cannulated screw internal fixation in the repair of femoral neck fracture can reduce the number of intraoperative fluoroscopy so as to reduce the radiation injury to medical staff and patients, shorten the operation time and reduce the amount of intraoperative blood loss during operation. It has more advantages in reducing surgical trauma and is more conducive to the recovery of postoperative hip joint function, but this method cannot improve the fracture healing effect; more high-quality randomized controlled trials are needed for verification in the future.

Key words: bone, femur, femoral neck fracture, hip joint, robot, screw, internal fixation, meta-analysis