BACKGROUND:The more vertical the femoral neck fracture line,the more shear force the femoral neck fracture may bear,so it may be prone to internal fixation failure,nonunion,or necrosis of the femoral head.At present,there is controversy as to which hollow nail fixation mode is ideal. OBJECTIVE:To evaluate different configurations and numbers of cannulated screw configurations to learn more about the biomechanical differences in vertical fractures of the femoral neck using finite element analysis. METHODS:Femoral CT data were collected from a 24-year-old healthy male volunteer and imported into Mimics software to build a three-dimensional geometric model of the femur.Model refinement and surface fitting processing were carried out in Geomagic software and imported into SolidWorks software to establish a vertical fracture model of the femoral neck.Six cannulated screw models were established,including three triangle configuration,three inverted triangle configuration,three double-plane double-support configuration(F scheme),three transverse configuration,four diamond configuration and four Alpha configuration.The peak stress,strain and displacement of internal fixation and femoral fracture models under different loads(350,700,1 400,and 2 100 N)were compared among different configurations. RESULTS AND CONCLUSION:(1)Under four kinds of loads,screw stress conditions were as follows:biplanar double-supported configuration(F scheme)>transverse configuration>inverted triangle configuration>positive triangular configuration>Alpha configuration>rhombus configuration.The peak value of Von mises stress was concentrated in the screw close to the fracture line.(2)Under four kinds of loads,the screw displacement was Alpha configuration>inverted triangle configuration>positive triangular configuration>biplanar double-supported configuration(F scheme)>rhombus configuration>transverse configuration,and the peak displacement was mainly concentrated on the hollow screw head.(3)Under four kinds of loads,the stress conditions of the proximal femoral bone block were biplanar double-supported configuration(F scheme)>transverse configuration>inverted triangle configuration>Alpha configuration>positive triangular configuration>rhombus configuration,and the stress peak mainly concentrated in the lower neck of femur.(4)Under 350 N load,the displacement of the proximal femur bone block was transverse configuration>biplanar double-supported configuration(F scheme)>positive triangular configuration>Alpha configuration>inverted triangle configuration>rhombus configuration.In the other three loads,the peak displacement of the inverted triangle configuration was smaller than that of the rhombus configuration.The peak displacement was mainly concentrated in the head.(5)The rhombus configuration was the most dispersed in the stress distribution of the proximal femoral bone.The rhombus configuration was the smallest in the peak displacement of the femur.The stress,displacement and peak displacement of the fracture end of each internal fixed model increased gradually with the increase of load.(6)The biomechanical performance of the four diamond-shaped models in the internal fixation of vertical femoral neck fractures is better than that of other groups of models.The four rhomboid models have stable fixation,small displacement value of fracture end and dispersed stress,which can help resist shear force and prevent varus collapse and create a good mechanical environment for fracture healing.

Osteoarthritis (OA) is a type of highly prevalent heterogeneous degenerative disease that leads to joint pain, deformity, the destruction of articular cartilage, and eventual disability. The current treatment strategies for OA often suffer from systemic side effects, poor anti-inflammatory efficacy, and persistent pain. To address these issues, we develop light-inducible nanomedicine that enables the co-delivery of anti-inflammatory drug (diacerein, DIA) and small interfering RNA (siRNA) targeting nerve growth factor (NGF) for pain relief to enhance the therapeutic efficacy of OA. The nanomedicine is based on poly(β-amino-ester)-coated gold nanocages (AuNCs), which is further incorporated with the phase-change material (lauric acid/stearic acid, LA/SA). Following intra-articular (IA) injection in vivo, the nanomedicine displays high degree of drug accumulation and retention in the joint lesion of OA mouse models. The photothermal effect, induced by AuNCs, not only promotes DIA and siRNA release, but also upregulates the expression of heat shock protein 70 (HSP-70) to resist the apoptosis of chondrocytes in the inflammatory condition. The internalization of both DIA and siRNA results in strong anti-inflammatory and pain-relieving effects, which greatly contribute to the joint repair of OA mice. This study offers a promising combination strategy for OA treatment.

BACKGROUND: Proximal femoral nail anti-rotation is widely used to treat various intertrochanteric fractures. Although its operation trauma is small, and the blood loss of perioperative period is still large. Tranexamic acid has been gradually used to reduce the bleeding of intertrochanteric fracture. The effectiveness and safety of reducing blood loss during perioperative period were not reported. OBJECTIVE: To explore the safety and efficacy of tranexamic acid on perioperative blood loss in patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation. METHODS: One hundred and eight patients with intertrochanteric fracture undergoing proximal femoral nail anti-rotation were selected from First Affiliated Hospital, Guangzhou University of Chinese Medicine between January 2015 and January 2017. Among all the subjects, 52 patients who received the operation before January 2016 served as the control group and 56 patients who received the operation after January 2016 were selected as the treatment group. Half an hour before operation, patients in the treatment group received 1 g tranexamic acid dissolved in 250 mL normal saline by intravenous dropping; patients in the control group just received 250 mL normal saline by intravenous dropping. The bleeding volume, blood transfusion volume, hemoglobin, hematocrit, coagulation index, D-dimer levels and complications were compared between the two groups. RESULTS AND CONCLUSION: (1) During perioperative period, actual blood loss, intraoperative blood loss, dominant blood loss, recessive blood loss, volume of drainage, blood transfusion volume and blood transfusion rate were lower in the treatment group than in the control group (P < 0.05). (2) There was no statistically significant difference in the hemoglobin and hematocrit between the two groups before operation (P > 0.05). The hemoglobin and hematocrit of the two groups gradually decreased after the operation, and there was a slight improvement in the fifth day after surgery. At postoperative 2 hours, 1, 3 and 5 days, the hemoglobin and hematocrit of the treatment group were higher than in the control group (P < 0.05). At preoperation and each time point postoperation, prothrombin time, activated partial thromboplastin time, and fibrinogen levels were not statistically significant between the two groups (P > 0.05). Postoperative D-dimer levels in the two groups were significantly higher than preoperation, and there was a return on the fifth day. There was no statistically significant difference between groups at preoperation and each time point of postoperation (P > 0.05). (3) The results suggest that the tranexamic acid can effectively reduce the dominant and recessive blood loss in patients with the intertrochanteric fracture, and it is safe and effective.