Orthopedic Research and Reviews最新文献

Bone tumors present complex challenges in orthopaedic oncology, requiring precise management strategies to restore skeletal integrity and function with minimal morbidity. Traditional autologous bone grafting has been the gold standard due to its osteogenic, osteoconductive, and osteoinductive properties. However, limitations such as donor site morbidity and graft availability have prompted the development of alternative approaches.This review evaluates contemporary approaches in bone tumor management, focusing on advancements in bone grafting techniques, bone graft substitutes (eg, ceramics, polymers, bioactive materials), and growth factor-based therapies. The efficacy and safety of these substitutes are compared with autografts, examining their potential benefits and drawbacks.Recent innovations in bone graft substitutes show promise in overcoming autograft limitations. Ceramic, polymer, and bioactive materials offer diverse properties that may enhance bone regeneration. Growth factor-based therapies, including bone morphogenetic proteins (BMPs) and vascular endothelial growth factor (VEGF), have revolutionized bone healing by stimulating osteogenesis and angiogenesis.

Background: The knee joint is primarily stabilized by the Anterior Cruciate Ligament (ACL). ACL tear, a common injury resulting from sudden shock or intense forceful knee movement, is characterized by an ACL sprain or stretch. In Saudi Arabia, the incidence of ACL damage is estimated at 31.4%. Injuries can be contact-based (direct collision) or non-contact (imbalanced or flawed movement).

Methodology: This cross-sectional observational study was conducted in the Jazan region of Saudi Arabia between December 2022 and May 2023 to assess personal and psychological perceptions of returning to activities after ACL reconstruction. The study included 113 patients; data was collected via self-administered questionnaire, and data analysis was performed using SPSS 23rd version. This study provides valuable insights into the factors affecting the return to activities after ACL tears.

Results: The study found that most patients were male. Football is the most common physical activity associated with knee injury. Postoperative complication rates were low. Sex, site of injury, and reoperation were significantly associated with the perceived importance of the exercise score. Muscle strengthening postoperatively and age were significantly associated with knee injury and osteoarthritis outcome scores. Site of injury and ACL- quality of life score of "social and emotional" segment were significant factors associated with ACL - quality of life score of "entertaining and physical activity" segment. This study provides valuable insights into the factors affecting the return to ACL tear activity in the Jazan region.

Conclusion: This study highlights the importance of patient education and support for safe exercise and emotional well-being after ACL. We found correlations between injury location and exercise perception, thus emphasizing the need for a safe environment. Postoperative strengthening and age- and sex-specific strategies are also important, and emotional support is critical for rehabilitation success. Further research on patients' beliefs, motivations, and provider communication is needed.

Objective: Osteoporosis and rheumatoid arthritis (RA) are commonly associated, but whether there is a causal genetic relationship between them remains unclear. This study used a two-sample Mendelian randomization (MR) approach to investigate this causal relationship.

Methods: Genetic instruments for osteoporosis and RA were obtained from published genome-wide association studies (GWAS). We selected SNPs with genome-wide significance (p < 5×10-8) and independent variation (r2 < 0.001). Causality was assessed using the inverse variance weighted (IVW) method, and heterogeneity, pleiotropy, and robustness were tested using Cochran's Q test, MR-Egger intercept, and leave-one-out sensitivity analysis.

Results: The MR analysis revealed a causal effect of decreased bone mineral density (BMD) on RA risk (TB-BMD: OR = 1.094, 95% CI = 1.023-1.170, P = 0.009; FA-BMD: OR = 1.159, 95% CI = 1.019-1.320, P = 0.025; LS-BMD: OR: 1.175, 95% CI = 1.070-1.291, P = 0.001). Osteoporosis at different sites and age groups significantly influenced RA, while RA did not significantly affect osteoporosis. Sensitivity analyses confirmed the robustness of the results.

Conclusion: Our study suggests a potential causal relationship between osteoporosis and RA, suggesting that osteoporosis may predispose individuals to RA. Further research is needed to understand the mechanisms and to confirm these findings across diverse populations.

Introduction: Osteoporosis leads to decreased bone density and an increased risk of fractures, with diabetic patients being particularly vulnerable. This study aims to evaluate the effects of five common antidiabetic drugs-Metformin, GLP-1 receptor agonists, SGLT2 inhibitors, Insulin, and Gliclazide-on the risk of osteoporosis subtypes and fractures, using Mendelian Randomization (MR) to ensure result accuracy.

Methods: Data from multiple Genome-Wide Association Studies (GWAS) databases were employed to assess the relationships between the use of these antidiabetic drugs and osteoporosis risk. The analysis utilized Mendelian Randomization techniques to minimize confounding and reverse causation, ensuring robust results.

Results: The findings reveal that: Metformin is significantly negatively associated with osteoporosis (OR [95% CI]: 0.00936 [0.0011-0.0806], p = 2.11×10⁻⁵), indicating a potential bone-protective effect by reducing bone resorption and enhancing osteoblast activity through the activation of the AMPK pathway. GLP-1 receptor agonists are significantly positively associated with osteoporosis with pathological fractures (OR [95% CI]: 1.1247 [1.0043-1.2594], p = 0.0420), suggesting a potential increase in fracture risk. SGLT2 inhibitors show a weak negative association with osteoporosis (OR [95% CI]: 0.8987 [0.8092-0.9980], p = 0.0429), though the effect is minor and unstable. Gliclazide significantly increases the risk of pathological fractures (OR [95% CI]: 1.03E+08 [1.28E+02-8.32E+12], p = 0.0395), indicating a need for caution in its use among patients at high fracture risk.

Discussion: The results highlight the potential bone-protective role of Metformin, which may be suitable for patients at high fracture risk. On the other hand, the use of GLP-1 receptor agonists and Gliclazide should be carefully considered, especially in individuals with osteoporosis or at high risk of fractures. These findings emphasize the importance of personalized medication management in diabetic patients to optimize bone health.

Urinary bladder entrapment or incarceration within pelvic fracture have been described in many reports in the literature, most of which were reported in adult patients. We describe a case of a 14-year-old boy presented with isolated locked symphysis pubis disruption after falling from a height. His initial evaluation was negative for any other associated injuries. The decision was made to treat him surgically by open reduction and internal fixation using a symphyseal plate; however, upon completing the Pfannenstiel incision, the surgeon faced a soft tissue mass hindering bony fragment dissection; upon careful examination, the soft tissue mass turned out to be entrapped urinary bladder within the symphyseal disruption. After careful soft tissue dissection, and with the help of Jungbluth distractor, the disruption was over-distracted, the bladder was freed entirely (which was intact) and reduced to its position, followed by the application of a symphyseal plate in a reduced symphysis pubis position. The patient did well postoperatively, and at three months follow up, the disruption and fracture united, and there were no urinary-related symptoms. Although rare, urinary bladder entrapment within an element of anterior pelvic fracture could be a reason for the difficult reduction; careful evaluation and steady soft tissue dissection are paramount for avoiding undue iatrogenic urinary bladder injury.

Tendon healing after ligament or tendon reconstruction remains a significant challenge. Regenerative tissue engineering, an interdisciplinary field that combines biology, materials science, and engineering, offers promising solutions. Recent developments have introduced scaffold materials designed to enhance the proliferation and differentiation of tendon-to-bone tissue cells. These scaffolds possessing three-dimensional composites of tissue cells and biomaterials, have proven effective in facilitating tendon-to-bone curing post-surgery. The successful development of the tendon-to-bone interface is a critical factor for early rehabilitation and functional recovery. In this mini-review, we present a comprehensive update on contemporary strategies for synthetic scaffold-based materials and their influence on tendon-to-bone healing. We described the synthetic materials compositions, structures and features of single-layer, multi-layer, and gradient scaffolds with their special mechanical properties. We examined the construction of engineering scaffolds from the perspectives of biomaterials and design strategies, providing a comprehensive evaluation of the advantages and disadvantages associated with each approach. Ultimately, this review articulates clear research directions aimed at achieving breakthroughs in future studies.

Introduction: Delayed union management is both challenging and expensive. Statins, which are HMG-CoA reductase inhibitors, induce bone morphogenetic protein-2 (BMP-2) gene expression, which in turn increases bone formation. Red yeast rice contains monacolin, which has a similar activity to lovastatin as an HMG-CoA reductase inhibitor. Red-yeast rice is readily available and inexpensive. This study aimed to demonstrate the effectiveness of red yeast rice in enhancing fracture healing in a delayed union model through increased expression of BMP-2.

Materials and methods: This experimental animal study was conducted using 24 delayed union Sprague-Dawley (SD) rats divided into four groups (n=6 each), consisting of; the 4-weeks-given-red yeast rice extract group (4RYR), 2-weeks-given-red yeast rice extract group (2RYR), 4-weeks-control group (4C), and 2-weeks-control group (2C). The animals were euthanized in the second and fourth week. Immunohistochemical staining was used to assess BMP-2 expression using an Immunoreactive Score (IRS). The fracture healing process was evaluated using histomorphometry by measuring the fibrous area, cartilage area, and woven bone area percentage.

Results: In the 2RYR group, there was significantly higher BMP-2 expression (p=0.03), less fibrous area (p=0.05), and larger cartilage area (p= 0.04) than in the 2C group. In the 4RYR group, there was significantly higher expression of BMP-2 (p=0.011), larger woven bone area (p=0.01), and less fibrous area (p = 0.03) than in the 4C group. There was also a significantly smaller fibrous area (p=0.02), a larger cartilage area (p=0.05), and a larger woven bone area (p=0.04) in the 4RYR group than in the 2RYR group. The BMP-2 expression in the 2RYR group was as high as that in the 4RYR group.

Conclusion: Red yeast rice effectively improved fracture healing by increasing BMP-2 expression in a delayed-union model in SD rats.

Introduction: The anterior cruciate ligament (ACL) is crucial for knee stability and joint movement coordination. ACL injuries are common, often leading to knee instability and subsequent complications. ACL reconstruction is a standard treatment option, with various autograft sources available. The anterior half of the peroneus longus (AHPL) tendon has emerged as a potential alternative autograft. This study aimes to examine the anterior knee pain in ACL reconstruction using AHPL.

Materials and methods: This study included 51 patients with ACL injuries undergoing ACL reconstruction using the AHPL tendon autograft. Patient demographics, surgical details, and Kujala scores were collected.

Results: The average age of our participants was 25.88 ± 5.39 years, with mean BMI classified as obese. Significant improvements in Kujala and KOOS pain scores were observed between each data collection. There was a negative correlation between baseline and three and six months post-operatively Kujala and KOOS pain scores with BMI.

Discussion: The study findings suggest that ACL reconstruction using the AHPL tendon autograft significantly reduced anterior knee pain, as indicated by a better Kujala and KOOS pain score. Previous studies have highlighted concerns regarding anterior knee pain with other autograft sources, such as the patellar and hamstring tendons. The AHPL tendon autograft offers a promising alternative with favorable anterior knee pain and minimal donor site morbidity.

Conclusion: In ACL reconstruction, the AHPL tendon autograft demonstrates excellent outcomes regarding anterior knee pain, as measured by the Kujala score.

Purpose: Osteoporosis is a common skeletal disease characterized by impaired bone microarchitecture, decreased bone mineral density and increased bone fragility, leading to a heavy physical and economic burden due to its greatly increased risk of fracture. Baji capsule is a proprietary medicine that can treat menstrual disorders and postmenopausal osteoporosis. However, the efficacy of Baji capsule has not been reported for osteoporosis caused by oxidative stress and inflammation. Therefore, the aim of this study was to evaluate whether Baji capsule has a therapeutic effect on lipopolysaccharide (LPS)-induced inflammatory osteoporosis and to explore the underlying mechanisms through network pharmacology.

Patients and methods: Osteoporosis model in ICR mice induced with LPS. Mice were treated with vitamin E (100mg/kg), PBS, high-dose Baji capsule (810mg/kg) and low-dose Baji capsule (90mg/kg), respectively. The therapeutic effect of Baji capsule was evaluated by high-resolution micro-computed tomography (Micro-CT) and tissue section staining, serum inflammatory factor levels were assessed by ELISA, serum oxidative stress-related marker levels were determined by kits, and finally the mechanism was explored by network pharmacology and then verified by immunohistochemistry.

Results: Micro-CT results showed that Baji capsule attenuated LPS-induced inflammatory bone loss.Baji capsule also reduced serum inflammatory factor levels and oxygen free radical production. Target screening by network pharmacology yielded a total of 236 active ingredients of Baji capsule, as well as 278 common targets after taking the intersection of Baji capsule active ingredient targets and osteoporosis disease-related targets.

Conclusion: Baji capsule can treat osteoporosis by reducing inflammation and oxidative stress. The therapeutic effects of Baji capsule were shown to be multi-targeted and multi-pathway through network pharmacology. In the future, its anti-inflammatory and antioxidant properties can be utilized to further explore its therapeutic effects on inflammatory diseases, as well as a prospective study for the clinical treatment of osteoporosis.

Introduction: Dystonia is a prevalent movement disorder characterized by involuntary muscle contractions, and cervical dystonia is among the most common forms. This report presents a rare case of severe isolated cervical dystonia in a young male patient that progressed to type IV atlantoaxial rotatory subluxation, highlighting the clinical presentation and diagnostic challenges associated with this condition.

Case description: A 27-year-old male patient presented with abnormal head posture and severe cervical pain. Clinical examinations revealed severe cervical muscle spasms and a unique head posture, as if he was looking at the tip of his right shoulder. Radiological evaluation revealed a type IV atlantoaxial rotatory subluxation. Despite initial attempt of close reduction under anesthesia, recurrence of the subluxation occurred, and surgical intervention was necessary.

Conclusion: This case underscores the importance of thorough clinical evaluation and imaging in the diagnosis of isolated cervical dystonia, particularly given its potential to present with atypical features. These findings suggest that early recognition and intervention may be critical for preventing complications and improving patient outcomes.