BMC Musculoskeletal Disorders最新文献

Background: Intervertebral disc (IVD) degeneration (IVDD) is one of the main causes of low back pain. One of the most important features of IVDD is the loss of extracellular matrix (ECM) with its structural components. Cartilage intermediate layer proteins (CILPs), minor glycoproteins residing in ECM, have been found to be increased in IVD as degeneration and aging progresses. The aim of the present study was to evaluate the expression of CILP-2 in the IVD of patients with lumbar radiculopathy.

Methods: The IVD samples were collected from 25 patients during spinal surgery (interlaminectomy, herniated disc removal). The control IVD samples were obtained from nine patients who underwent lateral corpectomies in the thoracic region. CILP-2 expression was detected by immunohistochemistry. The patients were divided into two groups - aged under or over 50 years. A standardized clinical examination with assessment of radicular signs and deficits was performed. Subjective disability and pain were assessed using the visual analogue scale and Oswestry Disability Index (ODI). The pre-operative MRI was graded for the degree of IVD degeneration by Pfirrmann grading system. IVD samples obtained during operations were subjected to the standardized histopathological analysis applying modified Boos classification. The data were analysed by t-test, Mann-Whitney U-test, and Spearman correlation test.

Results: Both histopathology scores and Pfirrmann grades did not differ between patients' groups. Also, no correlations were found between histopathology and Pfirrmann grades, neither were any differences seen when correlating both grades to ODI, back pain or leg pain scores. CILP-2 staining was noted in all studied samples, notably strong staining was seen around large cell clusters. However, no differences in CILP-2 staining were seen between the age groups of patients. No correlations were found between CILP-2 staining and Pfirrmann grades. Grading of CILP-2 immunostaining in nine control patient samples resulted in significantly lower values. The difference is statistically significant (P = 0.002) compared to CILP-2 staining scores of all 25 patients' samples.

Conclusion: In this study, we detected increased CILP-2 expression in the human IVD as compared to the control group patients. CILP-2 can be a possible IVDD marker; however, as knowledge about the role of CILP-2 is limited, further studies are required.

Background: Adult growth hormone deficiency (AGHD) is associated with an increased risk of fractures and impaired bone microstructure. Understanding the metabolic changes accompanying bone deterioration in AGHD might provide insights into mechanisms behind molecular changes and develop new biomarkers or nutritional strategies for bone destruction. Our study aimed to investigate the association between altered metabolite patterns and impaired bone microstructure in adult rats with growth hormone deficiency.

Methods: Thirty seven-week-aged adult Lewis dwarf homozygous (dw/dw) rats (five females and five males), and adult Lewis dwarf heterozygous (dw/ +) rats (five females and five males) rats were compared. Micro-computed tomography (Micro-CT) was used to examine the bone's microstructure. Hematoxylin and eosin (H&E) staining were used to quantify the histological characteristics. Liquid chromatography-mass spectrometry untargeted serum metabolomic analysis was applied in the study. ELISA was used to measure serum bone turnover markers and IGF-1 levels.

Results: Adult dw/dw rats exhibited great reductions in trabecular volume bone density (Tb.vBMD), bone volume/total volume (BV/TV), and cortical thickness (Ct. Th) compared with adult dw/ + rats (all p values < 0.05), indicating significant impairment in bone microstructure. The serum metabolite profiles revealed substantial differences between the dw/dw rats and dw/ + rats. A total of 134 differential metabolites in positive ion mode and 49 differential metabolites in negative mode were identified. Five metabolites, including Lysophosphatidylcholine(LPC) 20:3, LPC22:6, LPC22:4, cortisol and histamine levels were upregulated in dw/dw rats. The steroid hormone biosynthesis and bile secretion pathways were the main perturbed metabolic pathways. There were significant associations between differential metabolites and the impaired bone microstructure parameters, indicating that the selected metabolites might serve as potential biomarkers for deteriorated bone microstructure in AGHD.

Conclusion: Adult dw/dw rats exhibit impaired bone microstructure and distinct serum metabolic profiles, and the altered metabolites were significantly associated with bone microstructure destruction. This provides a new insight into understanding the mechanism of bone deterioration in AGHD patients from a metabolic perspective.

Intra-articular fractures of the distal radius require anatomical reduction and stable fixation. When the fracture encompasses the articular facet of the bone, maintaining the reduction is challenging due to the fragment's size and high instability. While specific implants have been developed to fix this fragment, their effectives have been limited. This study evaluates the mechanical performance of a novel hook plate conceived to stabilize the small fragment of the semilunar facet of the radius in non-osteoporotic bones. A simulated lunate facet fracture was created in an adult radius in a virtual model, and a modification of a hook plate was developed using computer-aided design (CAD). Two groups were established for the finite element method (FEM) simulation: a control group (standard plate Medartis™ (Switzerland, A-5500.23) and an angled plate with hooks set at 60º, 90º and 120º. In the FEM simulation, an axial load of 100 N was applied in the Z-axis direction on the fragment. Fracture displacement along the Z axis was more pronounced in the control model (0.32 mm) and less in the angled models, ranging from 0.22 to 0.28 mm. Notably, the plate with a 90° angle showed a more effective reduction in fragment displacement. The distribution of stresses in the system showed the highest levels of stress in the control group (59.31 MPa), followed by the subgroup with a 60° angle (55.78 MPa).In the side view, the control model showed a higher concentration of stresses (59.74 MPa), while the model with a 90° angle showed a lower value of stresses (18.87 MPa). Critical stress regions were identified in the bolts of the control and 120° models (59.47 MPa and 57.64 MPa, respectively). However, in the 90° model, no critical regions were observed in the bolts, which showed lower stress values, reaching 26.33 MPa. In the bone, the greatest concentration of stress occurred in the region where the plate was anchored. Our results showed that the 90° hook plate had a superior mechanical performance in fixing simulate lunate facet fractures at the distal radius. This angle led to minor displacements and minimized stress concentrations in the hardware, thus contributing to enhance the stability of this specific fracture.

In musculoskeletal pain (MSP), pain duration, disability, and mental health relate to how a person engages in daily activities. The self-reporting questionnaire Activity Patterns Scale (APS) assesses these activity patterns and their subscales: Pacing (Pacing to increase activity levels,Pacing to conserve energy for valued activities,Pacing to reduce pain); Avoidance (Pain avoidance,Activity avoidance); Pacing (Excessive persistence, Task-contingent persistence, Pain-contingent persistence). This investigation translated the APS into German and estimated its internal consistency, test-retest reliability, and construct validity. The APS translation was conducted following international guidelines for the transcultural adaptation of self-reported measures. For the construct validity, the Avoidance Endurance Fast-Screening (AE-FS), Tampa Scale of Kinesiophobia (TSK), and Coping Strategies Questionnaires (CSQ) scales were employed. Sixty-five participants with MSP contributed to a baseline survey with a follow-up at two weeks. The German version of the APS subscales demonstrated good internal consistency (Cronbach's alpha = 0.670-0.89) and satisfactory test-retest reliability (intraclass correlation coefficient = 0.72-0.82); only Task-contingent persistence revealed a poor result. Construct validity was supported by significant correlations between APS subscales (pacing, avoidance, persistence) with related measures, including the Coping Strategies Questionnaire (0.27 to 0.40; -0.50 to 0.55; 0.27 to 0.50), the Tampa Scale for Kinesiophobia (0.28 to 0.47; 0.36 to 0.37; 0.38), and Avoidance-Endurance Fast Screening Pain Persistence Scale (none; none; 0.40). The findings demonstrate high construct validity by the substantial correlations in the predicted directions for the APS subscales and their corresponding questionnaires. The German version of the APS is a reliable and valid tool for assessing activity pattern subscales in individuals with MSP. This distinction could refine research and customize treatment instructions to regulate people's activity in clinical practice.

Background: The risk of falls causing periprosthetic fracture has become an issue with the increase in the number of patients undergoing long-term follow-up after total hip arthroplasty (THA) and the aging of patients. The Timed Up and Go test (TUG) is utilized to evaluate fall risk. This study investigated muscle volume around the hip joint based on computed tomography (CT), CT value, and muscle strength to investigate contributing factors to poor TUG 1 year post-THA.

Methods: This study retrospectively investigated 124 patients with unilateral hip osteoarthritis who underwent THA and classified them based on TUG results at 1 year postoperatively into TUG of < 10 s (fast group [103 patients]) and ≥ 10 s (slow group [21 patients]). Body mass index, the volume and CT density of the psoas major and gluteus medius muscles on CT images, pre- and postoperative hip flexion muscle strength, and hip abductor muscle strength were compared in each group.

Results: Age was significantly older and preoperative abductor (fast Group: 1.0 ± 0.3 and slow Group: 0.7 ± 0.3, P = 0.003) and flexion muscle strengths (0.9 ± 0.3 and 0.7 ± 0.3, respectively, P = 0.02) on the healthy side were significantly lower in the slow group. The gluteus medius muscle demonstrated significantly lower CT density in the slow group on both sides. Nominal logistic regression analysis revealed that age and preoperative healthy abductor muscle strength, which are poor factors for TUG 1 year post-THA, were significantly associated with TUG of ≥ 10 s at 1 year post-THA.

Conclusions: The poor factors for TUG 1 year after THA were age and preoperative abductor muscle strength on the healthy side.

Background: Off-the-shelf stems offer a wide variety of fixation methods for revision arthroplasty and intercalary tumour implants. However, in extensive defects or needed resection with minimal bone stock left, solid fixation is often not feasible with these implants. Custom-made stem solutions (CSS) offer a viable alternative in these cases to achieve joint preservation.

Methods: Between 2017 and 2024 14 patients (15 implants) were treated in a single-centre study. CSS were indicated if the remaining bone stock was deemed insufficient for normal stem fixation due to tumour resection or previous operations. Postoperative analysis was conducted to evaluate the functional outcome as well as revision rates.

Results: Implantation was possible in all cases, during the follow-up of 30 (SD 18; 6-66) months revision was needed in five cases; with one aseptic loosening, one screw loosening and three PJI cases. Mean MSTS score was 24 (SD 5; 17-30).

Conclusion: Custom-made stem solutions show promising results in extreme cases. Especially as a preservation of the joint is possible, this treatment algorithm should be considered on a case-by-case basis.

Background: This study aimed to assess the quality and readability of large language model-generated responses to frequently asked questions (FAQs) about Kienböck's disease (KD).

Methods: Nineteen FAQs about KD were selected, and the questions were divided into three categories: general knowledge, diagnosis, and treatment. The questions were inputted into the Chat Generative Pre-trained Transformer 4 (ChatGPT4) webpage using the zero-shot prompting method, and the responses were recorded. Hand surgeons with at least 5 years of experience and advanced English proficiency were individually contacted over instant WhatsApp messaging and requested to assess the responses. The quality of each response was analyzed by 33 experienced hand surgeons using the Global Quality Scale (GQS). The readability was assessed with the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease Score (FRES).

Results: The mean GQS score was 4.28 out of a maximum of 5 points. Most raters assessed the quality as good (270 of 627 responses; 43.1%) or excellent (260 of 627 responses; 41.5%). The mean FKGL was 15.5, and the mean FRES was 23.4, both of which are considered above the college graduate level. No statistically significant differences were found in the quality and readability of responses provided for questions related to general knowledge, diagnosis, and treatment.

Conclusions: ChatGPT-4 provided high-quality responses to FAQs about KD. However, the primary drawback was the poor readability of these responses. By improving the readability of ChatGPT's output, we can transform it into a valuable information resource for individuals with KD.

Level of evidence: Level IV, Observational study.

Background: Slipped capital femoral epiphysis (SCFE) is usually seen in patients with high body mass index (BMI) and endocrine diseases. SCFE is exceedingly rare among Cerebral palsy (CP) patients due to spasticity present in those patients. Percutaneous in situ fixation is the treatment option for SCFE patients. According to the literature, there's no single case report with SCFE in a spastic CP patient with no prior history of trauma, seizure episodes, or endocrine disease.

Case presentation: We report a case of an 11-year-old spastic cerebral palsy (CP) patient with a physical status of level 5 motor function on the gross motor function classification system. He was brought by his mother to the clinic complaining of bilateral hip pain. The mother denied any history of trauma or any seizure episodes. The pain had started spontaneously. Physical examination showed severe spasticity and bilateral hip abduction with external rotation. Drehmann's sign was positive. Bilateral hip radiographs revealed bilateral partial open femoral capital physis with evidence of SCFE bilaterally. Also, the Southwick angle was measured, and it was severe. The patient was taken to the operating room and treated with closed reduction and percutaneous in situ fixation. He was seen multiple times following surgical intervention, reporting pain relief, and showing complete wound healing.

Conclusion: This report concludes that paraplegic spastic CP patients may present with SCFE spontaneously without trauma, seizures, or an underlying endocrine disease. Also, severe spasticity might potentially be a risk factor for SCFE, although further investigations would be necessary to establish a conclusive link.

Background: Osteoporosis is characterized by low systemic bone mineral content and destruction of bone microarchitecture. Promoting bone regeneration and reversing its loss by infusion of exogenous bone marrow mesenchymal stem cells (BMSCs) is a potentially effective treatment for osteoporosis. However, their limited migration to target organs reduces the therapeutic effect of the cells. Stromal cell-derived factor 1 (SDF1) is a chemokine that induces targeted cell migration through the SDF1/CXCR4 (C-X-C chemokine receptor 4) axis and can induce migration of exogenous mesenchymal stem cells to sites of high SDF1 concentration. There are no studies on BMSCs overexpressing SDF1 (SDF1-BMSCs) in osteoporotic mice in vivo. We aimed to investigate if the increased SDF1 concentration facilitated cell migration to the bone.

Methods: We used lentivirus to construct BMSCs overexpressing SDF1 or knocking down CXCR4. We verified the proliferation ability of the cells in vitro using Cell Counting Kit-8 (CCK8) and 5-Bromodeoxyuridinc (BrdU), the migration ability of the cells using Transwell, and the osteogenic and lipogenic ability of the cells using osteogenic and lipogenic induction solutions. In in vivo experiments, we induced osteoporosis in 72 female mice by ovariectomy and injected different groups of cells via the tail vein. Femoral tissue samples were collected for a fixed time, and the osteogenic and homing abilities of the cells were verified by MicroCT and tissue section staining.

Results: We successfully demonstrated that high expression of SDF1 promoted cell proliferation and migration in vitro, without affecting their cell differentiation ability. In an ovariectomized mouse model, SDF1-BMSCs were more likely to be home to the femur than the BMSCs, had a better pro-osteogenic ability, and had higher expression of Wnt-1. Blocking the SDF1/CXCR4 axis reduced the homing of exogenous mesenchymal stem cells (MSCs) to the femur and their osteogenic capacity.

Conclusions: SDF1-BMSCs can further promote bone formation by increasing the number of cells homing to the femur in osteoporotic mice. Our study shows that stem cells can promote their proliferation and home to the femur via the SDF1/CXCR4 axis and further help bone formation via Wnt-1 signaling.

Background: Osteoporosis (OP) is a complex skeletal disorder characterized by reduced bone mass, microarchitectural deterioration of bone tissue, and increased susceptibility to fractures. Bone mineral density (BMD), as the best indicator of bone mineral content per unit area of bone, is one of the key diagnostic factors for OP. Platelets (PLT), serving as important immune cells and components of the coagulation system, have been demonstrated to be associated with bone formation, resorption, and remodeling processes. However, no research has established the relationship between BMD and platelet count (PC) in the American population thus far. This study aims to investigate the correlation between BMD and PC among the American population, and to appraise the effects of additional risk factors on this association.

Methods: This investigation examined the relationship between BMD and PC by analyzing data from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. A weighted multivariate logistic regression analysis was employed to assess this correlation. Additionally, subgroup and smooth curve analyses were conducted to delve deeper into the BMD-PC relationship and to identify other potential determinants of PC.

Results: This study reveals a significant negative correlation between BMD and PC in the American adult population (β=-15.05, 95% CI: -22.07 to -8.03, p < 0.0001). Subgroup analysis highlights notable differences in this correlation between genders and various racial groups. Smooth curve fitting and generalized additive models were applied to further explore the relationship between BMD and PC, considering the influence of multiple factors.

Conclusion: The present study investigated the correlation between BMD and PC in adults, with a particular focus on the potential risk factors for thrombocytopenia. This negative correlation was found to be markedly pronounced in males, an association not observed in females. Additionally, a potential inverse relationship between BMD and hemoglobin (HGB) levels was identified. Consequently, for individuals with elevated bone mass or osteoporosis (OP), we advocate for routine complete blood count monitoring to identify hematological irregularities. Considering the significant variations by sex, age, and race, special vigilance is advised for changes in PC among non-Hispanic white males under the age of 55.