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BACKGROUND: Treatment strategies for femoral neck fractures include cannulated screw fixation, dynamic hip screw fixation, intramedullary nail fixation, locking plate fixation, and hip replacement. However, the best treatment for Pauwels type III femoral neck fractures is still controversial. OBJECTIVE: To analyze the biomechanical characteristics of a novel femoral neck system for unstable femoral neck fractures by using a three-dimensional finite element analysis method. METHODS: The CT imaging data of the femur of a healthy volunteer were selected and imported into the medical three-dimensional reconstruction software Mimics 21.0 to obtain the original three-dimensional model of the femur. The model was exported to an STL format file and imported into the Geomagic Wrap2017 software for optimization so as to construct femoral cortical bone and cancellous bone structure. The optimized model was imported into Solidworks2017 software, and the 3D model of Pauwels type III femoral neck fracture was reconstructed through Boolean operation. The Pauwels angles are set to 50°, 60° and 70°, respectively. Solidworks2017 software was used to establish three types of internal fixation models (femoral neck system, positive triangular hollow screw, and inverted triangular hollow screw) based on clinical fixation procedures and engineering geometric data modeling. Finally, Abaqus2017 software was used for meshing. After applying load and data calculation, the stress distribution, peak stress and maximum displacement of femur and internal fixation were analyzed in each model. RESULTS AND CONCLUSION: (1) No matter what the angle of the fracture, the stress of the proximal femur in the three internal fixation models was mainly distributed near the medial femoral talus and spread to the surroundings. Among them, the inverted-triangular hollow screw group had the largest stress. The femoral neck system group had the smallest stress. (2) Regardless of the angle of the fracture, the stress of the internal fixation device in the three internal fixation models was mainly distributed on the middle surface of the screw near the fracture line, and the inverted triangle hollow screw group had the least stress, and the femoral neck system group had the largest stress. (3) No matter what the angle of the fracture, the peak displacement of the femur in the three internal fixation models was mainly concentrated on the top of the femoral head. Among them, the peak displacement was the largest in the inverted triangular hollow screw group, and the smallest in the femoral neck system group. (4) No matter what angle of fracture, the peak displacement of the internal fixation device in the three internal fixation models was mainly at the top of the screw. The peak displacement was the largest in the positive triangle hollow screw group, and the smallest in the femoral neck system group. (5) The results show that the biomechanical stability of the femoral neck system for the treatment of unstable femoral neck fractures is better than that of hollow screws, and the risk of internal fixation failure is lower than that of hollow screws. [ABSTRACT FROM AUTHOR]

BACKGROUND: With the development of three-dimensional (3D) printing technology, it has been widely used in spinal surgery. However, whether 3D printing-assisted surgery for lumbar spondylolisthesis has an advantage over traditional surgery is still controversial. OBJECTIVE: To compare the clinical efficacy and safety of 3D printing-assisted versus conventional surgery for the treatment of lumbar spondylolisthesis using system evaluation. METHODS: Randomized controlled trials about 3D printing technology for lumbar spondylolisthesis in CNKI, Wanfang database, CBM, VIP, PubMed, Cochrane Library, Embase, and Web of Science were searched via computer from inception to November 16, 2019. The retrieved literatures were screened according to predefined inclusion and exclusion criteria, and quality evaluation was performed. Then, the available data were extracted and analyzed with the Stata 11.0 software. RESULTS AND CONCLUSION: (1) Six randomized controlled trials including 394 cases were included. Among them, 201 cases were assigned to the 3D printing-assisted group and 193 cases to the conventional group. (2) Meta-analysis results showed that the 3D printing-assisted group proved significantly superior to the conventional group regrading the operation time [WMD=-38.17, 95%CI(-43.93, -32.41), P=0.00], intraoperative blood loss [WMD=-61.61, 95%CI(-69.19, -54.03), P=0.00], the frequency of fluoroscopy [WMD=-4.89, 95%CI(-6.38, -3.41), P=0.00] and the screw placement accuracy [OR=3.89, 95%CI(2.43, 6.25), P=0.00]. (3) However, in terms of the postoperative visual analogue scale scores [WMD=-0.47, 95%CI(-1.21, 0.27), P=0.215], Oswestry disability index [WMD=-1.41, 95%CI(-2.87, 0.05), P=0.058], Japanese Orthopaedic Association scores [WMD=1.02, 95%CI(-0.68, 2.72), P=0.240] and the rate of complications [OR=0.37, 95%CI(0.12, 1.11), P=0.075], no statistically significant differences were found between the two groups. (4) In conclusion, the application of 3D printing technology in the surgical treatment of lumbar spondylolisthesis has the advantage of shortening the operation time, reducing intraoperative blood loss and frequency of fluoroscopy and improving the accuracy of the screw placement. [ABSTRACT FROM AUTHOR]

BACKGROUND: Intraarticular injection of corticosteroids after arthroscopic shoulder surgery is one of the effective methods to relieve shoulder pain and stiffness after surgery. However, whether the use of corticosteroids will increase the complications associated with arthroscopic shoulder surgery is still controversial. OBJECTIVE: To evaluate the safety and clinical efficacy of corticosteroid injections after arthroscopic shoulder surgery. METHODS: The electronic databases including PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for clinical controlled trials of corticosteroid injection into the articular cavity after arthroscopic shoulder surgery from the inception of the databases to September 2019. Data extraction and quality appraisement were performed independently by two investigators according to inclusion and exclusion criteria. Merging and analysis of effect quantities was conducted on RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of six comparative studies were included. A total of 7 418 patients were enrolled, of which 3 920 were in the corticosteroid injections group and 3 498 in the control group. (2) Meta-analysis showed that there was no significant difference in tear rate, Constant score, ASES score and UCLA score between the two groups [OR=0.71, 95%CI[0.45, 1.13], P=0.15; MD=-0.99, 95% CI(-12.44, 10.46), P=0.87; MD=-0.12, 95%CI(−1.80, 1.56), P=0.89; MD=−1.46, 95%CI(−3.22, 0.30), P=0.10]. The infection rate of corticosteroid injections group was higher than that of control group (P < 0.05). There was no significant difference in infection rate between the two groups 2-4 months after arthroscopy (P > 0.05). (3) The results showed that the injection of corticosteroids did not increase the rate of postoperative tear, but the injection of corticosteroids within one month after the operation would increase the rate of postoperative infection. Therefore, when using corticosteroids after the operation, clinicians should weigh the advantages and disadvantages according to the actual situation of patients, and pay attention to avoid injecting intraarticular hormone treatment within 1 month after operation. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo Zuzhi Gongcheng Yanjiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

BACKGROUND: Proximal humerus fracture is the third major fracture type after hip fracture and distal radius fracture in the elderly. The treatment of proximal humeral fractures is diverse. The latest research in recent years has found that the third-generation multi-dimensional locking humeral intramedullary nail system has shown good clinical results in the treatment of proximal humeral fractures, but the current optimal treatment for proximal humeral fractures remains controversial. OBJECTIVE: To systematically evaluate the clinical efficacy of Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humeral fractures. METHODS: The electronic databases of CNKI, Wanfang, VIP, PubMed, Embase, and the Cochrane library, which last updated in February, 2019, were searched for clinical controlled trials regarding Multiloc intramedullary nail versus PHILOS locking plate in the treatment of proximal humerus fracture. The methodological quality of each publication was critically appraised using the Newcastle-Ottawa Scale appraisal tool and a meta-analysis was performed with the Cochrane Collaboration’s Rev Man 5.3 software. RESULTS AND CONCLUSION:(1) Eight studies including 267 patients were analyzed.(2) The results of meta-analysis revealed that Multiloc intramedullary nail group had significantly better outcomes in Constant score(MD=1.98(0.65, 3.31), P=0.004), American Shoulder and Elbow Surgeons shoulder score [MD=3.59(1.61, 5.57), P=0.000 4], external rotation(MD=4.55(2.19, 6.91), P=0.000 2), operation time [MD=-13.11(-25.47,-0.74), P=0.04), healing time [SMD=-0.46(-0.47,-0.18), P=0.001), and blood loss [MD=-66.44(-102.25,-36.62), P < 0.000 1) than the PHILOS plate group.(3) However, there were no significant differences in Visual Analogue Scale scores, anterior flexion and uplifting flexion, and adverse reactions between the Multiloc intramedullary nail and PHILOS plate groups(P > 0.05).(4) Results of meta-analysis showed that compared with PHILOS locking plate, Multiloc intramedullary nail had the advantages of shorter operation time, less bleeding, quicker recovery of shoulder function, and faster healing time, but the incidence of postoperative acromion impingement, screw cut, humeral head necrosis and varus deformity was similar between these two groups. Relatively speaking, Multiloc intramedullary nails have a better clinical outcome than PHILOS locking plate. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo Zuzhi Gongcheng Yanjiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)