Abstract:[Objective] To compare the clinical efficacy of robot-assisted versus traditional freehand percutaneous cannulated screwfixation for femoral neck fracture. [Methods] A retrospective analysis was performed on 69 patients who received surgical treatment for Pau-wels type II-III femoral neck fractures in our hospital from April 2021 to April 2022. According to doctor-patient communication, 39 pa-tients were treated with robot-assisted fixation (the robot group), while other 30 patients underwent conventional free-hand percutaneouscannulated screw (the free hand group). The perioperative, follow-up and imaging data of the two groups were compared between the twogroups. [Results] The robot group proved significantly superior to the free hand group in terms of operation time [(61.9±13.5) min vs (87.0±14.4) min, P＜0.001], the total length of incision [(2.2±0.4) cm vs (5.2±0.4) cm, P＜0.001], intraoperative blood loss [(29.3±4.8) ml vs (33.0±7.8) ml, P=0.018], intraoperative fluoroscopy times [(6.7±1.2) times vs (9.8±1.1) times, P＜0.001] and guide pin adjustment times [(4.5±1.1)times vs (7.9±0.9) times, P＜0.001]. In addition, the robot group resumed full weight-loading activity time significantly earlier than the freehand group [(104.6±4.3) days vs (108.7±8.1) days, P＜0.001]. The VAS score, Harris score, hip extension-flexion ROM, and hip internal-ex-ternal rotation ROM significantly improved in both groups over time (P＜0.05). The robot groups was significantly better than the free handgroup in terms of Harris score [(85.3±3.4) vs (82.2±3.3), P＜0.001] a month postoperatively, [(87.0±2.6) vs (82.8±4.2), P＜0.001] 6 monthspostoperatively; hip flexion-extension ROM [(89.6±7.2)° vs (86.6±5.0)°, P=0.045] a month postoperatively, [(105.2±4.6)° vs (102.8±4.0)°,P=0.030] 6 months postoperatively; and hip internal-external rotation ROM [(58.0±2.7)° vs (54.7±2.5)°, P＜0.001] a month postoperatively.Regarding image, the robot group was also significantly better than the free hand group in term of Garden alignment index, cannulatedscrew dispersion and femoral neck shortening (P＜0.05), but there were no statistically significant differences in femoral neck-shaft angle and cannulated screw parallelism, fracture healing time and Ficat grade between the two groups (P＞0.05). [Conclusion] Compared withhands-free technique, the robot-assisted cannulated screw fixation of femoral neck fracture has the advantages of shorter operation time,better screw placement with greater dispersion, and better early hip function recovery.