BMC Musculoskeletal Disorders最新文献

Background: Angioleiomyoma is a benign tumor arising from smooth muscle that is commonly found in the foot and ankle. This systematic review aims to synthesize the limited data from numerous case reports and case series, which often involve small sample sizes, to provide orthopaedic surgeons with a comprehensive overview of the diagnosis and management of foot and ankle angioleiomyoma.

Methods: This systematic review, performed following the PRISMA guidelines, brings updated information for the diagnosis and management of foot and ankle angioleiomyoma. 62 relevant studies were included. We analysed patient demographics, clinical characteristics, diagnostic workup, treatment, and clinical outcomes.

Results: Angioleiomyoma is more prevalent in middle-aged women, and pain is the most common symptom. Its diagnosis is often delayed due to its rarity and nonspecific presentation. Plain radiographs, MRI, and ultrasound of the foot and ankle are the most common preoperative imaging exams. Surgical excision is the treatment of choice with a low rate of both recurrence and malignant transformation.

Conclusions: This review emphasizes the importance of considering angioleiomyoma in the differential diagnosis of foot and ankle tumors and highlights the need for a comprehensive workup to improve diagnostic accuracy and ensure appropriate management.

Background: Hip replacement is a popular orthopedic surgery. The methods include SuperPATH and traditional hip replacement. The efficacy and safety of SuperPATH vs. traditional hip replacement might be an intriguing topic.

Methods: The SuperPATH vs. traditional hip replacement comparison for the operation characteristics, hospitalization duration, postoperative pain and hip scores were set for the current systematic review and meta-analysis, which can help us determine the differences in the operation characteristics, hospitalization duration, postoperative pain severity and postoperative hip function between the 2 groups. Only randomized controlled trials (RCT) were eligible and 9 RCTs (299 patients with the superPATH, and 379 patients with traditional hip replacement) were enrolled. We focused on the operation characteristics, hospitalization duration, pain, and hip function after orthopedic surgery.

Results: The meta-analytic results showed that SuperPATH might be associated with a significantly shorter incision length and hospitalization duration. In addition, the postoperative pain severity was lower and the postoperative hip function was better in the SuperPATH group when compared to traditional hip replacement.

Conclusions: The SuperPATH might be beneficial for patients with hip replacement surgery when compared to the traditional hip replacement from the perspective of incision length, hospitalization, pain severity, and hip function. Further RCT studies with a more homogeneous study design and a greater sample size might be warranted in the future.

Background: Spontaneous psoas hematoma is a very rare clinical entity, and the pathogenesis and pathologic mechanisms of spontaneous psoas hematoma remain unclear, thus, it is of great value to explore.

Case presentation: We encountered a patient who developed femoral nerve paralysis due to psoas muscle hematoma following posterior lumbar fusion surgery. A 69-year-old female with lumbar spinal canal stenosis underwent posterior lumbar fusion at the L3-4 and L4-5 levels. On the 7th postoperative day, the patient complained of severe abdominal pain along with right limb pain and weakness. A computed tomography image showed a large acute psoas muscle hematoma on the right side. After conservative treatment, the psoas hematoma was resolved and the patient's femoral nerve paralysis gradually recovered.

Conclusions: Spontaneous psoas hematoma is a rare and extremely dangerous complication after lumbar spine surgery. For high - risk patients who have taken anticoagulants before the operation, we must be vigilant against the occurrence of this complication.

Background: Patellar fracture surgeries are associated with subsequent atrophy and weakness in the muscles of the lower limb. Individualized blood flow restriction training is progressively being recognized as a potential technique for improving muscular hypertrophy and accompanying strength in participants recovering from surgery. This study aimed to investigate the overall feasibility and observational outcomes of individualized blood flow restriction training for participants recovering from patellar fracture surgery.

Methods: A 47-year-old male (Participant one, body mass: 65 kg, height: 1.75 m, body mass index: 21.2 kg/m², three months post-patellar fracture surgery) and a 28-year-old female (Participant two, body mass: 53 kg, height: 1.67 m, body mass index: 19.8 kg/m², three months post-patellar fracture surgery) performed straight leg raises and leg extensions with individualized blood flow restriction for six weeks. The blood supply to the leg with the patellar fracture was partially restricted using a thigh pressure cuff inflated to 60% of the limb occlusion pressure. Peak torque of knee extensor, rectus femoris cross-sectional area, rectus femoris stiffness, and Lysholm score were measured at baseline and post-training.

Results: Compared to baseline, the post-training peak torque of the knee extensor, rectus femoris cross-sectional area, rectus femoris stiffness, and Lysholm score of participants one post-surgical leg increased by 48.2%, 7.9%, 7.9%, and 23 points, respectively; those of participant two increased by 134.7%, 6.8%, 14.2%, and 30 points, respectively.

Conclusions: The results showed that the individualized blood flow restriction training was feasible and suggested promising outcomes for participants after surgery. Further research with a large sample size is required to flesh out and generalize the training program.

Trial registration: The Nanjing First Hospital's ethics committee accepted the research before testing. The clinical test was documented with clinicaltrials.gov (NCT05371431, Registered 08-20-2020, prospectively registered).

Background: This meta-analysis aimed to pool the existing evidence to determine the clinical efficacy and safety of mesenchymal stem cells (MSC) in patients with non-unions.

Methods: A systematic search in PubMed and Scopus was performed until October 2024 to gather pertinent studies. The inclusion criteria included participants with non-unions, the intervention of MSC administration, a comparator of standard treatment (bone graft), and outcomes focused on healing rate, healing time, or side effects. The Jadad score Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias in randomized and non-randomized studies, respectively. Moreover, GRADE criteria were used to assess the quality of evidence. Using a random effects model, odds ratios (OR) with 95% confidence intervals (CIs) were calculated for healing and complication rates, while standardized mean differences (SMD) with their 95% CIs were used to assess the impact of MSC therapy on bone union time.

Results: Twenty-one studies, with 866 patients, were included. The bone healing rates were 44% at 3 months, 73% at 6 months, 90% at 9 months, and 86% at 12 months, eventually reaching 91% after 12 months of follow-up. MSC therapy, with or without scaffolds, was linked to higher odds of bone healing rate at 3 and 6 months, compared to bone grafts as the standard care (OR = 1.69). The time to union following the treatment was 6.30 months (95%CI: 86-96%), with patients treated with MSC/Scaffold experiencing a shorter time compared to MSC alone (5.85 vs. 6.36 months). MSC therapy significantly decreased bone union time (SMD:-0.54 months, 95% CI: -0.75 to -0.33). The complication rate was 1% (MSC/Scaffold: 0%, MSC alone: 2%), with MSC alone or MSC/Scaffold showing a lower risk than the standard care (OR = 0.41, 95% CI: 0.22-0.78).

Conclusion: MSC is a potential adjunct therapy for patients with non-union fractures.

Clinical trial number: Not applicable.

Background: An effective and appropriate method to support the ankle joint optimally is particularly important during the healing phase of ankle fractures. The purpose of this review was to assess the functional outcomes, ankle-related quality of life, and associated complications of cast immobilization versus removable braces for the treatment of adult ankle fractures.

Methods: Studies comparing cast immobilization and removable braces after ankle fracture were included by systematic searches of PubMed/MEDLINE, Web of Science, Scopus, and EMBASE databases according to PRISMA (Preferred Reporting Items for Systematic Evaluation and Meta-Analysis Statements) guidelines. Primary outcome measures included early to mid-late Olerud Molander Ankle Score (OMAS). Secondary outcomes were ankle dorsiflexion and plantarflexion, swelling, pain, time to return to work, calf muscle atrophy, and complications. Subgroup analysis was performed. Risk of bias was assessed in both randomized controlled trials and cohort studies.

Results: Eleven studies including 1485 patients met the eligibility criteria. The fracture types of the study included Weber A/B/C and Lauge-Hansen supination external rotation (SER), supination-adduction (SA), pronation-external rotation (PER) and pronation-abduction (PA). The results of the meta-analysis showed that removable braces had better early (mean difference (MD) -2.14; 95% confidence interval (CI) -4.26, 0.00) and mid-term functional outcomes (MD -5.81; 95% CI -10.35, -1.27) after ankle fracture compared with cast immobilization. In addition, removable braces caused significantly more wound breakdown (Odds ratio (OR) 0.39; 95% CI 0.17, 0.90) and wound infections (OR 0.32; 95% CI 0.17, 0.58) than cast immobilization.

Conclusion: Compared with cast immobilization, removable braces had better functional outcomes in the early and mid-term periods after ankle fractures and were less likely to result in deep vein thrombosis (DVT). Overall, the removable brace is a comfortable ankle fracture option that might improve functional outcomes.

Background: Low back pain(LBP) is very common among the population, and intervertebral disc(IVD) degeneration is considered to be the most common cause of LBP, but the pathophysiological process between IVD degeneration and LBP is not very clear. We conducted this study to clarify the interplay between quantitative magnetic resonance imaging (MRI) parameters, including q-Dixon and T2 mapping, and clinical symptomatology in patients with LBP.

Methods: All LBP patients underwent lumbar spine MRI, encompassing q-Dixon and T2 mapping. The severity of pain was classified based on Oswestry Disability Index (ODI) scores. Midsagittal T2 and T2* mapping were used to assess anterior annulus fibrosus (AAF), nucleus pulposus (NP), and posterior annulus fibrosus (PAF), as well as vertebral bone marrow fat fraction (BMFF). ANOVA and Pearson's correlation analyses facilitated the comparative evaluation of MRI parameters with respect to Pfirrmann grades and ODI scores.

Results: 95 LBP patients were included (41 males, 54 females), with an average age of 44.39 ± 17.44. The T2 values of AAF and PAF were different and weakly correlated between most Pfirrmann grades (r = 0.435, 0.414). T2 and T2* values of NP were different and negatively correlated between all Pfirrmann grades (r=-0.844, -0.704), except for grade IV vs. V, revealing decreasing values for grades I-V. BMFF was different and moderately correlated (r = 0.646) between most Pfirrmann grades, except for grade V vs. grade III and IV. The T2 values of AAF, NP, and PAF, the T2* values of the NP, and the BMFF of the vertebrae could distinguish low pain from moderate and severe pain.

Conclusion: The T2 and T2* values of AAF, NP, PAF, as well as the BMFF of the vertebrae, can reflect intervertebral disc (IVD) degeneration and may be potentially used to quantitatively detect causes behind LBP.

Background: Knee osteoarthritis (KOA) is a common joint disorder, and intra-articular injections of hyaluronic acid (HA) or platelet-rich plasma (PRP) are frequently employed therapeutic interventions. However, there remains controversy regarding their efficacy. This systematic review aims to compare the effectiveness and safety of HA and PRP through a meta-analysis, with the objective of identifying the optimal treatment protocol for KOA and enhancing its management.

Methods: Randomized controlled trials evaluating the clinical outcomes of patients receiving intra-articular injections of either HA or PRP were included as eligible studies. Two independent investigators assessed the selected studies and evaluated their risk of bias. Primary outcome measures included the Visual Analog Scale (VAS) score, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and other relevant assessment indices. Dichotomous variables were analyzed using risk ratios (RR) with 95% confidence intervals (CI). Data analysis was conducted using RevMan software (version 5.3).

Results: A total of forty-two randomized controlled trials were included in this meta-analysis. No significant differences were observed between the patient populations in the two groups. The analysis demonstrated that PRP resulted in lower VAS and WOMAC scores compared to HA. Additionally, PRP exhibited superior performance across other evaluation indices. Notably, the incidence of adverse events was higher in the PRP group; however, all reported complications were mild.

Conclusions: Based on the current evidence, intra-articular injection of PRP appears to be more effective than HA for the treatment of KOA, as indicated by the analysis of VAS, WOMAC scores, and other evaluation indices.

Trial registration: Retrospectively registered.

Background: Transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH) is considered technically demanding, with varying results among institutions. This is due to the complex soft tissue exposure and determination of the osteotomy line. We report a case in which the osteotomy line was assessed using the Stryker OrthoMap^® three-dimensional (3D) computed tomography (CT)-based navigation system and determined as preoperatively planned.

Case presentation: The patient was a 24-year-old male with alcohol-related ONFH. Japanese Investigation Committee Classification Type C2/C2 Stage 3b/3b was confirmed through magnetic resonance imaging, and TRO was performed bilaterally on the same day using the Stryker OrthoMap^® 3D CT-based navigation system. The patient was hospitalized for 55 days, and full loading was allowed at 6 months postoperatively. Eight months after surgery, the patient could return to work at his previous job in the restaurant industry relatively quickly. One and a half years postoperatively, the functional score improved from a preoperative visual analog scale of 90 to 12 mm at and the Japanese Hip Society Hip Evaluation Questionnaire improved from 31 points preoperatively to 59 points.

Conclusions: This is the first report of a bilateral TRO for bilateral ONFH performed on the same day using CT-based navigation. For osteonecrosis, which is often bilateral, accurate determination of the osteotomy line as planned preoperatively using CT-based navigation contributes to shorter operative time, less intraoperative blood loss, and allows for bilateral same-day surgery. This may improve situations in which patients are hesitant to undergo bone-preserving surgery because of the long period of time required to return to work, thereby facilitating their early reintegration into society.