BMC Musculoskeletal Disorders最新文献

Background: An oligopeptide hepcidin is encoded by the human HAMP gene (Hamp in mice). Its deficiency can result in iron overload, while excess may lead to iron deficiency. Hepcidin knockout mice exhibited iron accumulation in multiple tissues, accompanied by degeneration of bone microarchitecture and reduced biomechanical properties. Astronauts who are exposed to weightlessness during prolonged spaceflight experience bone loss. After space missions, an interrelation exists between iron stores and bone mineral density (BMD). Bone loss in mice due to unloading is linked to iron excess and involves hepcidin. The potential role of hepcidin in unloading-induced bone loss remains unclear.

Methods: Our study conducted relevant experiments using hepcidin knockout mice and their primary osteoblasts as the research subjects. We used the hindlimb unloading (HLU) model and the random positioning machine (RPM) system to simulate weightlessness in vivo and in vitro.

Results: HLU mice exhibited reduced hepcidin levels in the serum and liver. Hepcidin knockout further diminished BMD and bone mineral content (BMC) in the femurs of HLU mice. Similarly, the bone volume fraction (BV/TV) and connectivity density (Conn.Dn) followed this downward trend, whereas trabecular separation (Tb.Sp) showed an inverse pattern. Moreover, hepcidin knockout decreased the ultimate load and elastic modulus in the tibias of HLU mice. Hepcidin knockout decreased PINP levels in the serum, a commonly used marker for bone formation, alongside elevated iron levels in the serum, liver, and bone of HLU mice. We also found higher serum MDA and SOD levels in these mice. In vitro, experimental data indicated that hepcidin knockout suppresses the osteoblastic differentiation capacity under RPM conditions. Additionally, this condition upregulates SOST protein levels and downregulates LRP6 and β-catenin protein levels in osteoblasts.

Conclusion: Hepcidin knockout exacerbates bone loss in HLU mice, most likely due to reduced osteoblastic activity.

Background: Although movement representation techniques has originally been used in neurological rehabilitation, growing researches suggests that it may also introduce advantageous effects to individuals with orthopaedic injuries. This systematic review and meta-analysis aimed to investigate the effects of these techniques on pain, range of motion, muscle strength, functional performance and fear of movement in individuals after orthopaedic surgeries.

Method: Five electronic databases were searched until April 2024. Two reviewers independently conducted study selection and data extraction. Randomized controlled studies containing individuals after limb surgeries were identified. The quality of enrolled studies and the overall certainty of evidence was assessed by scales, respectively. Egger's test and funnel plot were used to assess publication bias. Subgroup analysis was also conducted to explore the source of heterogeneity.

Results: Twenty-one randomized controlled trials involving 659 postsurgical participants were identified. The meta-analysis suggested moderate-quality evidence of a positive effect on pain intensity (SMD=-0.85; 95% CI -1.26, -0.43; p < 0.001). A low quality of evidence pointed toward a positive effect on functional scales (SMD=-0.84, 95% CI -1.27, -0.41, p < 0.001) and range of motion (SMD = 0.8, 95% CI 0.24, 1.35, p = 0.005). The very low quality of evidence suggested a significant effect on the functional test results (SMD=-0.8, 95% CI -1.01, -0.58, p < 0.001). The results remained nonsignificant for muscle strength and fear of movement. Intervention quantity, Disability of Arm, Shoulder, and Hand (DASH) score and intervention content were the sources of heterogeneity for pain intensity, functional scale score and range of motion, respectively.

Conclusion: Compared with conventional rehabilitation, movement representation techniques increase pain relief, functional performance and range of motion. Our results support the use of mental practice techniques in individuals after orthopaedic surgeries, with moderate to very low-quality evidence.

Review registration: This trial was registered on PROSPERO on 10 August, 2024 (CRD42024583380).

Adult spinal deformity (ASD) is a spectrum of abnormalities of the thoracic and lumbar spine and has an increasing prevalence. It is associated with significant physical and mental disability in symptomatic patients. Given the increased rates and the morbidity associated with this disease, novel innovation in the diagnosis and treatment of such deformity is required. The SRS-Schwab classification system described coronal scoliotic deformity with sagittal modifiers. Other parameters, such as the sagittal vertical axis, pelvic tilt, T1 pelvic angle, pelvic incidence and lumbar lordosis attempted to quantify global sagittal balance. More recently, a focus on more patient specific parameters has been targeted to improve patient outcomes. The Roussouly classification system attempted to predict sagittal alignment parameters based on fixed parameters of the pelvis. Others determined the parameters based on patient age. Technological advances have also enhanced our understanding of ASD. Long cassette films and automated analyses have allowed standardization of these measurements across physicians. 3D printing has been used as an adjunct for both surgical planning and implants, both generic and patient specific, to improve outcomes. With these, advances in minimally invasive approaches have allowed ASD correction with lower complications and blood loss. Intraoperative navigation and the use of robotics has allowed improved accuracy in the care of these patients. Development of complex osteotomies have allowed for correction of advanced deformity. Fusion, however, is the ultimate goal of surgical ASD correction. Advances in biologics such as the use of recombinant Human Bone Morphogenetic Protein-2 have been used to improve fusion rates and combat pseudoarthrosis. Finally, post-operative advances in ASD patient care with emphasis on enhanced recovery after surgery has allowed improvements in hospital length of stay and pain scores. ASD is becoming a more ubiquitous diagnosis for spine surgeons with an increasing aging population. Improvement in the understanding of the diagnosis, spinopelvic parameters, imaging techniques, and post operative care are all aimed toward helping patients in whom care can be extremely difficult. Further study in ASD patient care will target advanced innovation to provide optimal treatment to these patients and allow for best possible outcomes.

Objective: Osteoarthritis (OA) is closely related to aging, and autophagy is implicated in the retardation of aging. Activated synoviocytes play important roles in OA; the synoviocytes could produce osteopontin (OPN) and its main receptors CD44 and integrin, which are all involved in OA. The purpose of this study is to investigate whether OPN has an effect on autophagy in osteoarthritic synoviocytes.

Methods: We cultured human OA fibroblast-like synoviocytes (FLS) and treated them with rhOPN and antibodies against CD44 and CD51/61 (αvβ3 integrin) or isotype IgG to block the interaction between receptors and ligands. Infection with lentivirus mRFP-GFP-LC3, laser confocal imaging and Western blotting were used to determine changes in the expression of autophagy markers, and cell proliferation of FLS was assessed with a CCK-8 assay.

Results: Our results showed the expression level of autophagy marker protein LC3 II and the mRFP-GFP-LC3 puncta were significantly decreased after treatment with rhOPN when compared with the control group, when the FLS were incubated with antibodies against CD44 or CD51/61 (αvβ3 integrin) or with control isotype IgG for 1 h, followed by rhOPN treatment for 48 h, rhOPN could suppress the relative expression of LC3 II and Beclin1 via integrin and CD44 in the FLS, CCK-8 assay also showed that rhOPN significantly increased the cell proliferation and viability of FLS.

Conclusions: OPN could inhibit autophagy via CD44 and αvβ3 integrin and promote the proliferation of FLS, playing an important role in OA synovitis.

Purpose: The purpose of this study was to evaluate whether the combination of preoperative planning software combined with arithmetic hip-knee-ankle angle (aHKA) can help patients who underwent uni-compartmental knee arthroplasty (UKA) recover the constitutional alignment of the lower limb, obtain a better prosthetic position, and achieve better early patient-reported outcome measurements (PROMs).

Methods: A total of 150 patients who underwent UKA (planning group: 50 patients using the preoperative planning software; conventional group: 100 patients using the conventional method) were included in the study. The aHKA was defined as 180° + mechanical medial proximal tibial angle (MPTA) - mechanical distal lateral femoral angle (LDFA). All patients in the planning group underwent UKA according to the planning software with the planned lower limb alignment of aHKA. All patients were divided into three groups: constitutional alignment group (postoperative HKA (post-HKA): aHKA ± 2.0°); overcorrection group (post-HKA > aHKA + 2.0°); under-correction group (post-HKA < aHKA - 2.0°). Comparisons between the planning and conventional groups were conducted: (1) the proportion of post-HKA restored to constitutional alignment group; (2) the postoperative prosthesis position parameter based on the guideline of the Oxford group; (3) the American Knee Society scores (KSS) at six months after surgery.

Results: The proportion of the constitutional alignment group in the planning group was higher than that in the conventional group (86% vs. 66%) (p = 0.033). There was no significant difference in postoperative prosthesis position parameters between the two groups. No significant difference was found between the KSS clinical score (91.02 ± 4.20 vs. 90.61 ± 4.24) and KSS functional score (86.10 ± 7.23 vs. 84.30 ± 6.82) in six months after surgery between the planning and conventional groups.

Conclusion: Patients who underwent UKA using preoperative planning software in combination with aHKA were able to recover a higher proportion of the constitutional alignment than those with the conventional method. In addition, the planning group could achieve similar postoperative prosthesis position and short-term PROMs compared to the conventional group.

Clinical trial number: Not applicable.

Aim: We aimed to systematically review and conduct a meta-analysis of the available evidence about the association between dietary acid load (DAL) and fractures in adults.

Method: Relevant studies were searched through Web of Science, Scopus, PubMed, and Google Scholar until October 2024. The random-effect model was used to calculate the pooled Odd ratios (OR) and 95% confidence intervals (CIs). Publication bias was evaluated by statistical test of Egger. Subgroup analyses were conducted by study confounders. Moreover, the quality of studies was asessed using the Newcastle Ottawa Scale which is designed for observational studies.

Results: Six studies were included in this review. According to the methodological heterogeneity between studies and their different charactristics, we performed the analysis based on random-effect model that indicated a marginally significant association between DAL and risk of fracture (N event = 5275, Pooled OR: 1.10; 95% CI: 0.99-1.21, P = 0.073) (I² = 12.9%; P = 0.321). According to subgroup analysis, there was no significant association between DAL and risk of fracture in the cross-sectional effect sizes (N event = 337, OR:0.69; 95%CI:0.47-1.00). There was a significant association between DAL and a greater risk of fracture in cohort studies (N event = 4938, OR:1.12; 95%CI:1.03-1.22, P = 0.006). Also, high-quality studies (OR:1.12; 95%CI:1.03-1.22; P = 0.006) showed a significant association between DAL and fracture risk.

Conclusion: DAL was marginally related to a higher risk of fracture. This finding is a trigger for bone health management with a healthy balanced dietary intake.

Background: Low back pain (LBP) is a long-lasting condition with a variable course rather than pain episodes of unrelated occurrences. Thus, the remission stage between the symptom recurrence is critical. This study aimed to investigate the trunk control of the symptom remission people with low back pain (LBP-R) during gait based on a multi-segmental spine model, including the musculoskeletal factors of lumbar muscle activity and regional thoracic and lumbar kinematics.

Methods: Twenty-one males (10 LBP-R, age 23-37, height 165-185 cm, weight 60-74 kg; 11 controls, age 23-38, height 164-183 cm, weight 55-80 kg) were evaluated using 3D motion analysis and surface electromyography (sEMG). The thoracic (T) and lumbar (L) spine were divided into upper and lower portions separately (T3-T7; T7-T12; T12-L3; L3-L5). This pilot study investigated the segmental redundancy with the cross-correlation analyses of spine kinematic time series (R_xy) and correlation analyses of the range of motion between adjacent segments (R_ROM) during gait. Meanwhile, the bilateral lumbar erector spinae (ES) and multifidus (MF) muscle activation during the stance and swing phases were calculated respectively.

Results: The Upper Thoracic/Lower Thoracic pairing in the sagittal plane significantly showed a very strong correlation (R_xy:0.93) in the LBP-R group, while the controls displayed a weak correlation (R_xy:0.22). In addition, the Lower Thoracic/Upper Lumbar and Lower Lumbar/Pelvis pairings in the sagittal plane for the LBP-R group significantly showed very weak to weak correlations (R_xyrange: 0.17-0.24), while the healthy controls displayed moderate correlations (R_xyrange: 0.49-0.52). Most R_ROM values demonstrated very weak to moderate correlations (Number of pairings: 21/24). Compared with healthy controls, left-side ES muscle activation in the LBP-R group was significantly greater during the ipsilateral swing phase and smaller during the ipsilateral stance phase (P < 0.05).

Conclusions: Compared with healthy controls, the LBP-R group exhibited higher lumbar ES activation during the swing phase and altered movement redundancy between adjacent spinal segments in the sagittal plane. As effectively mechanical biomarkers, such findings may help establish a new approach to rehabilitation and self-management for LBP experiencers. A larger sample size is required to generalize these findings to the broader population.

Background: Double crush syndrome (DCS) is a relatively rare nerve compression syndrome among peripheral nerve compression diseases. However, ulnar nerve double entrapment caused by peri-cubital tunnel ganglion cysts has been rarely reported.

Case presentation: Here, we present a case of a 54-year-old woman who experienced occasional pain, numbness and paralysis in her right half hand for 1 year. A B-ultrasound of the right elbow initially revealed cubital tunnel syndrome only. Further Magnetic Resonance Imaging (MRI) showed a ganglion cyst near the cubital tunnel. After evaluation, we performed open surgery to excise the cyst and incise the cubital tunnel, completely decompressing the ulnar nerve entrapment. Ulnar nerve anterior transposition was also performed simultaneously.

Conclusions: The patient was followed up for 1 month, and she experienced a complete recovery with no functional limitations.

Clinical trial number: Not applicable.

Background: OLIF (oblique lumbar interbody fusion) is a minimally invasive surgery to treat spinal instability. However, clinical studies indicated the early degeneration of adjacent segments after surgery. The rod stiffness of OLIF was associated with change at adjacent segments. Therefore, the study aimed to compare the biomechanical effects of OLIF with different rod material properties using the finite element (FE) method.

Methods: A validated L1-L5 lumbar spine was conducted in the biomechanical analysis using FE software ANSYS. The FE model of OLIF with a rod was created. Current biocompatible materials for the rod of the OLIF model were changed, including titanium alloy (OLIF_Ti), nickel-titanium alloy (OLIF_NiTi), and polycarbonate urethane (OLIF_PCU) rod. Four FE models, consisting of the intact model (INT) and implant models, were created. Hybrid control loads, such as flexion, extension, rotation, and lateral bending, were subjected to four models on the L1 vertebral body. The bottom of the L5 vertebral body was fixed.

Results: At the surgical level, while compared to the INT model, the OLIF_Ti and OLIF_NiTi model resulted in a ROM reduction of over 40% at least, but the OLIF_PCU changed about 10% in flexion and extension. At adjacent level L2-L3, the FE results indicated that the OLIF_Ti and OLIF_NiTi model increased more stress by about 12% at least than the INT model at the adjacent segment, but it demonstrated that the OLIF_PCU would not result in stress rise at the adjacent level L2-L3 in flexion and extension.

Conclusion: The study concluded that rod stiffness was associated with change at the adjacent segments. The use of OLIF surgery with PCU rods can minimize the impact of the adjacent segment after lumbar fusion.