BMC Musculoskeletal Disorders最新文献

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: 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.

Osteoporosis (OP), a systemic bone disease, is characterized by degeneration of bone microstructure and susceptibility to fracture. Teriparatide (TPD) is an active fragment of human endogenous parathyroid hormone which has been revealed to promote osteogenesis of mesenchymal stem cells (hMSCs) to alleviate osteoporosis. Currently, the underlying cellular and molecular mechanisms of TPD in treating OP were not fully understood. This study aimed to investigate the roles of non-coding RNA-regulated osteogenic differentiation of hMSCs under TPD treatments. Circular RNA FNDC3B was significantly downregulated, and miRNA-125a-5p was upregulated in primary hMSCs of osteoporosis patients. Moreover, during osteogenesis, expression of circFNDC3B and glutamine metabolism were gradually elevated and miR-125a-5p was suppressed. Silencing circFNDC3B or overexpression of miR-125a-5p remarkedly suppressed the TPD-induced osteogenic differentiation-related genes (ALP, RUNX2, osteocalcin, osteonectin) activity or expression and calcium deposition of hMSCs. Results from RNA pull-down, RNA IP and luciferase assays demonstrated that circFNDC3B sponged miR-125a-5p, which further targeted 3'UTR of glutaminase (GLS), a key enzyme in glutamine metabolism to form a ceRNA regulator network. Rescue experiments demonstrated under TPD treatment, silencing of circFNDC3B significantly upregulated miR-125a-5p expression, blocked GLS expression and inhibited osteogenic differentiation evidenced by the suppressed ALP activity and expressions of osteocalcin, osteonectin and RUNX2. These regulatory phenotypes were further overridden by miR-125a-5p inhibition. In summary, our study demonstrated that TPD treatment promoted osteogenic differentiation of hMSCs by regulating the circFNDC3B-miR-125a-5p-GLS pathway.

Background: Musculoskeletal disorders (MSDs) are common work-related conditions that affect the musculoskeletal system owing to poor ergonomic practices, overexertion, and repetitive motions. Globally, MSDs account for a significant proportion of disabilities due to the physical tasks and demanding nature of jobs. Despite global efforts to reduce occupational hazards, little information is available on MSDs among quarry workers in Gambia. Therefore, this study aimed to explore the prevalence of MSDs and their associated factors in quarry workers in Gambia.

Methods: This study adopted an analytical cross-sectional design that was conducted in 2023. A total of 258 quarry workers were selected from 4 quarries in the West Coast Region. Participants were randomly selected and the Standardised Nordic Questionnaire (SNQ) was modified and used with additional structured questionnaires. Data were collected using the Kobo Collect App and analyzed using IBM SPSS version 27.0. Bivariate analysis was conducted using binary logistic regression, Pearson's chi-square test, point-biserial correlation, and Fisher's exact test to identify the association between predictors and outcome variables. Statistical significance was considered at a p-value < 0.05, and the significance was also reported using an adjusted odds ratio (aOR) with a 95% Confidence Interval (CI).

Results: The study revealed a high MSD prevalence of 93% among quarry workers, with the most affected body parts being the lower back (90.3%), shoulders (68.1%), and upper back (61.3%). Significant associations were observed between MSDs and factors such as nationality (p = 0.048), job description (p = 0.047), BMI score (p < 0.001), periodic health examination (p = 0.031), years of experience (p = 0.029), health and safety training (p = 0.044), and lifting or carrying weights (p = 0.044). Quarry workers whose nationality was Gambian had 82.8% (aOR = 0.172; 95% CI = 0.048-0.619) reduced odds of sustaining MSDs when compared to respondents whose nationality was non-Gambian. Increasing years of experience had 15.0% (aOR = 0.850; 95% CI = 0.725-0.997), increase in hours of daily work had 40.3% (aOR = 0.597; 95% CI = 0.386-0.925), and increasing BMI score had 29.9% (aOR = 0.701; 95% CI = 0.584-0.841) reduction in the odds of sustaining MSDs. However, increasing household size among quarry workers had 1.26 (aOR = 1.261; 95% CI = 1.015-1.566) higher odds of sustaining MSDs.

Conclusion: This study underscores a critical public health concern with the high prevalence of MSDs among quarry workers in The Gambia, which is associated with poor ergonomic training and inadequate safety training. Reducing the burden of MSDs in this population requires interventions that focus on better working conditions, ergonomic training, and regular health evaluations.

Background: The learning curve of total hip arthroplasty (THA) using the anterior approach in the supine position is considered to be long owing to limited surgical field visualization. This study aimed to investigate the learning curve of a trainee's cup placement using computed tomography (CT)-based navigation, focusing on identifying the number of cases required to achieve proficiency.

Methods: This retrospective cohort study included 112 hips that underwent total hip arthroplasty using CT-based navigation via anterolateral approach in the supine position by a trainee surgeon who had performed fewer than 20 prior THA cases. The absolute differences in cup alignment between postoperative measurements and intraoperative records, and differences in three-dimensional position between postoperative measurements and preoperative plan were assessed using the Mann-Whitney U test. A receiver operating characteristic (ROC) curve was used to determine the cutoff point for achieving accuracy.

Results: The absolute differences were 2.4°±2.5° (inclination) and 2.4°±2.0° (anteversion), and 1.5 mm ± 1.3 mm (coronal plane) and 1.4 mm ± 1.2 mm (axial plane). The ROC curve identified 20 cases as the cutoff point for proficiency, with significant improvement in cup inclination accuracy. Multivariate analysis revealed that the first 20 cases (odds ratio, 10.4; 95% confidence interval, 3.1-34.5) were a predictive risk factor for inaccurate cup alignment. No cup revisions or dislocations occurred.

Conclusions: This is the first study to identify the learning curve of cup placement using CT-based navigation via an anterior approach by an inexperienced trainee surgeon. Proficiency in cup placement was achieved after 20 cases using CT-based navigation.

Background: The Charnley stem design has evolved, with notable modifications from the 6th generation (Elite Plus) to the 7th generation (C-stem), potentially affecting load transmission and clinical outcomes. This study aimed to compare the clinical, radiological, and survival outcomes between the Elite Plus and C-stem.

Methods: A retrospective review was conducted on 131 primary total hip arthroplasties in 115 patients. A minimum 10-year follow-up was completed for 89 hips (78 patients) with the Elite Plus and 42 hips (37 patients) with the C-stem, with mean follow-ups of 15.8 and 11.7 years, respectively.

Results: The surgical procedures were hybrid arthroplasty with lateral and posterior approach for the Elite Plus group and cement arthroplasty with anterior and lateral approach for the C-stem group. In the Elite Plus group, five patients experienced dislocations and three developed aseptic loosening (AL); in the C-stem group, three cases of periprosthetic fracture (PPF) occurred. Four cases in the Elite Plus and two cases in the C-stem group required revision arthroplasty. The reasons for revision surgery were AL of the acetabular component in two cases and femoral AL in two cases in the Elite Plus group and PPF in two cases in the C-stem group. Radiolucent lines were significantly more frequent with the Elite Plus (33.7%) than with the C-stem (11.9%). After excluding three patients with extreme subsidence (≥ 3 mm) in the Elite Plus group, the average stem subsidence was found to be significantly larger with the C-stem (0.88 mm) than with the Elite Plus (0.17 mm) (p < 0.001, Mann-Whitney U test). With revision surgery due to any reason as the endpoint, the 10-year survival rates were 96.6% for the Elite Plus and 95.2% for the C-stem, showing no significant difference. However, survival rates differed significantly with PPF as the endpoint (100% for the Elite Plus vs. 92.9% for the C-stem, p = 0.01).

Conclusions: Both stems achieved satisfactory 10-year outcomes. The Elite Plus stem showed more frequent loosening and radiolucent lines, whereas the C-stem demonstrated a stable cement-bone interface but had several PPF cases. Design differences likely contributed to these variations in outcomes.

Background: Various conservative and non-conservative methods have been debated for their effectiveness in treating relapsed idiopathic congenital talipes equinovarus (CTEV). The aim of this work was the assessment of repeating Ponseti method in management of relapsed idiopathic CTEV in children less than two years of age.

Methods: This prospective study was carried out on 50 clubfeet in 33 children aged 10 months - two years, who had relapsed idiopathic CTEV after documented complete correction of the initial deformity with Ponseti method and initiation of a bracing protocol, between April 2022 and April 2024. Before, during, and after the last cast removal, as well as at the end of follow-up, the Pirani scoring system was utilized to evaluate each clubfoot.

Results: The mean age was 12.5 ± 6.08 months. Sex was male in 26 (52%) patients. The side was right in 28 (56%) patients. Pirani score was significantly lower after the last cast removal and at the end of follow up than before treatment (P < 0.001).

Conclusion: Relapsed idiopathic CTEV in children less than two years of age were effectively managed with the repeating of Ponseti method.

Type of study/level of evidence: Therapeutic IV.

Trial registration: Not applicable.

Cinical trial number: Not applicable.

Background: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are valuable markers for detecting periprosthetic joint infection (PJI) post-total knee arthroplasty (TKA). However, their prolonged elevation after TKA diminishes diagnostic reliability. This study investigates CRP and ESR trends in unilateral (U-TKA) and simultaneous bilateral TKA (SB-TKA) patients, comparing their patterns.

Methods: Between 2017 and 2023, preoperative and postoperative (weeks 2, 4, 6) CRP and ESR levels were assessed in U-TKA (32 patients) and SB-TKA (29 patients) groups for gonarthrosis.

Results: Median preoperative CRP levels were 1.13 mg/dL (U-TKA) and 0.2 mg/dL (SB-TKA), with corresponding ESR levels of 13.50 mm/h and 10 mm/h. While CRP and ESR increased more in SB-TKA, differences were statistically insignificant (p > 0.05). Both groups showed significant differences in CRP and ESR values at all time points (p < 0.05). U-TKA patients reached CRP < 5 mg/dL and ESR < 30 mm/h by the 6th postoperative week. SB-TKA patients did not exhibit significantly higher CRP and ESR levels at various intervals compared to U-TKA patients (p > 0.05).

Conclusion: This study delineates postoperative CRP and ESR trends in U-TKA and SB-TKA for osteoarthritis. CRP values decreased below 5 mg/dL, and ESR values below 30 mm/h within 6 weeks in both groups. Statistically significant differences in CRP and ESR values were observed at all time points. No significant differences were found in CRP and ESR trends between both groups. These findings aid physicians in interpreting laboratory reports for PJI determination.

Level of evidence: III.

Background: Instrument-assisted soft tissue mobilization (IASTM) is popular in the treatment of musculoskeletal disorders. However, the current literature has produced varying results. The purpose of this study was to collect the most recent studies to evaluate the effectiveness of IASTM on pain and function in patients with musculoskeletal disorders.

Methods: The researchers searched the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to February 25, 2025, to identify randomized controlled trials comparing treatment groups receiving IASTM combined with other treatments to those receiving other treatments among participants with musculoskeletal disorders. The outcomes were pain intensity, pain pressure threshold and function. The Cochran Q and I² indices were used to estimate heterogeneity. The data were analyzed as the standardized mean difference (SMD). The Cochrane Risk of Bias tool was used to assess the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate the quality of evidence. Trial sequential analysis and sensitivity analyses were also performed.

Results: Eleven trials (involving 427 participants) were included in the quantitative analysis. Six trials had a high risk of bias; three, unclear; and two, low. There was moderate-certainty evidence indicating that IASTM was effective in reducing patient-reported pain (n = 11) (n = 427, SMD = 0.60, 95% CI: 0.41 to 0.80, p < 0.01), and there was low-certainty evidence indicating that IASTM was effective in improving patient-reported function (n = 8) (n = 333, SMD = 0.40, 95% CI: 0.03 to 0.77, p < 0.05). Only one data point was extracted for the pain pressure threshold, and a meta-analysis was not performed. Trial sequential analysis revealed that the cumulative z score crossed the monitoring boundary for superiority for patient-reported pain in patients with nonspecific chronic neck pain and cervicogenic headache at the 4-week IASTM.

Conclusions: IASTM can reduce patient-reported pain (with moderate certainty) and improve patient-reported function (with low certainty) in patients with musculoskeletal disorders. Future clinical studies do not need to explore the short-term effects of IASTM on patient-reported pain in patients with nonspecific chronic neck pain and cervicogenic headache.

Trial registration: The PROSPERO registration ID is CRD42024534643 (April 10, 2024).