On September 20, the reporter learned from the Third Xiangya Hospital of Central South University that professor Luo Ling's team and the operating room team of the hospital successfully completed a vascularized iliac bone flap transplantation operation with the assistance of Da Vinci robot, which is used to protect the hip of young adults with comminted femoral neck fracture. According to literature review, this is the first time in the world that a robotic technique has been used for pedicled iliac flap transplantation. This means that young and middle-aged hip preservation has a new "unlocking method" of pioneering microscopic orthopedic surgery, which is expected to provide more advanced treatment methods for the prevention and treatment of femoral head necrosis in this population.
The hip preservation operation was performed on a young male patient with comminuted fracture of the neck of the right femur. The patient's fracture is an unstable fracture, and the blood supply of the fracture site and femoral head may be completely interrupted, which is easy to bring about the hidden danger of non-union of fracture and disability caused by ischemic necrosis of femoral head. Luo ling explained that for elderly patients with unstable fractures, the international practice is to implement artificial hip replacement, but it is not particularly suitable for young and middle-aged patients. Young and middle-aged people have high requirements on joint movement ability and weight-bearing ability. After replacement, patients are prone to undergo replacement surgery again or even several times due to wear and loosening of artificial joint. Therefore, the best way is to avoid femur head necrosis, namely "hip preservation".
However, simple hip preservation internal fixation cannot fundamentally solve the problem of blood supply to the fractured end and femoral head. Therefore, at present, the main method of hip preservation surgery recognized by orthopaedic circle is iliac bone graft and fibula graft with vascular pedicled. But there are also "hard risks", such as the difficulty of the operation and the risk of injury and complications. How to reduce the surgical injury and reduce the risk of surgery has become a new proposition of minimally invasive surgery in orthopaedic field.
Luo's team tried to deal with this "hard injury" with robotics. The team carried out rigorous certification of the use of robotic surgery, as well as detailed anatomical studies and animal experiments. Finally, on September 17, the team performed the world's first Da Vinci robot-assisted vascularized iliac bone graft. Compared with traditional open surgery, robot-assisted technology can cut the operating time in half or more, Said Luo. There was also less trauma, less bleeding, less pain, and a higher survival rate of the transplanted iliac flap, with a lower expected necrosis rate of the femoral head.
