BMC Musculoskeletal Disorders最新文献

Fractures will impair or disrupt angiogenesis, resulting in delayed union or non-union. Exploring angiogenic signaling molecules and related pathways can promote fracture healing. In this study, the roles of different endothelial cell (EC) subsets in fracture healing were observed using single-cell RNA sequencing (scRNA-seq). It was found that mpECs did affect the repair and regeneration of fracture sites, and could up-regulate genes related to the Notch signaling, angiogenesis, and cell cycle. In addition, in this study, Piezo2 expression was successfully knocked down by transfection of shRNA in human umbilical vein endothelial cells (HUVECs) for in vitro assays. The results suggested that the reduced expression of Piezo2 in HUVECs can suppress cell proliferation and cell cycle and further impair the activation of the Notch signaling pathway, inhibiting angiogenesis. Subsequently, HUVECs were intervened with the Notch pathway inhibitor DAPT and agonist Jagged1. It was found that inhibition of the Notch signaling pathway by Piezo2 knockdown was more significant in the presence of DAPT, whereas Jagged1 reversed the Piezo2 knockdown-caused changes in the downstream protein expression of the Notch pathway. With Jagged1, Piezo2 knockdown-induced decrease in HUVEC tube formation disappeared. Moreover, the tube formation was significantly enhanced, with a marked increase in tube length. Cell counting kit-8 (CCK-8) assay and flow cytometry demonstrated that Jagged1 can promote cell proliferation and trigger cell cycle entry. In conclusion, Piezo2 affects the phenotype of ECs by modulating the Notch signaling pathway and further promotes angiogenesis, thus accelerating fracture healing.

Background: Transphyseal hematogenous osteomyelitis(THO) has been considered a potential cause of severe sequelae due to its damage to the growth plate. It has been reported that growth disturbance would take place if the area of involvement exceeds 7%. However, the growth plate seems to have more potential to recover and regain normal function.

Case presentation: We report three cases of hematogenous osteomyelitis(HO) in children (ages 9 weeks, 4 years, and 13 years respectively ) with significant physeal involvement. All patients underwent surgical debridement and antibiotic therapy. Follow-up assessments demonstrated full recovery, with normal knee movements, no pain and equal limb length. Complete recovery of the physeal plate morphology and normal subsequent development were observed.

Conclusions: THO in children may have the chance of complete recovery after proper treatment, suggesting that the physeal plate has a great potential for self-recovery.

Clinical trial number: Not applicable.

Background: Current research on osteoporosis (OP) in hemophilia is insufficient. The suitability of high-resolution peripheral quantitative computed tomography (HR-pQCT) for evaluating osteoporosis in hemophilia remains unclear.

Aim: To investigate the current status of osteoporosis and the applicability of HR-pQCT in adult hemophilia patients.

Methods: Thirty three hemophilia patients aged 23-49 years were recruited. X-ray examinations were performed on the bleeding joints. Dual energy X-ray absorptiometry (DXA) and HR-pQCT were used to assess bone mineral density (BMD). The HR-pQCT values of the distal tibia and radius were compared between hemophilia patients and healthy controls(HCs).

Results: All bleeding joints showed local osteoporosis on X-ray. Only 33.3% of patients had a hip BMD lower than the expected value according to DXA. The Tb.vBMD(98.5 ± 44.2 mg/cm³), Tt.Ar(612.5 ± 163.5mm²),Tb.Ar(487.0 ± 175.6mm²), Ct.Ar(117.0 ± 25.7mm²), Tb.BV/TV(0.2 ± 0.1), Tb.N(0.9 ± 0.3 1/mm), Ct.Pm(96.3 ± 13.8 mm) of the distal tibia and Tt.Ar(248.4 ± 53.1mm²),Tb.Ar(186.0 ± 55.1mm²), Ct.Ar(66.1 ± 14.4 mm²), Ct.Pm(68.1 ± 7.1 mm) of the distal radius in the hemophilia group was significantly lower than the HCs(tibia Tb.vBMD:186.4 ± 44.3mg/cm³, Tt.Ar:906.8 ± 135.0mm²,Tb.Ar:743.7 ± 137.6mm², Ct.Ar:169.3 ± 21.9mm²,Tb.

Bv/tv: 0.3 ± 0.1, Tb.N:1.5 ± 0.2 1/mm,Ct.Pm:117.8 ± 8.2 mm; radius Tt.Ar:285.7 ± 35.6 mm², Tb.Ar:83.8 ± 7.9mm², Ct.Ar:0.3 ± 0.1mm², Ct.Pm:80.2 ± 4.3 mm) with statistically significant differences (p < 0.05). Correlation analysis showed a positive correlation (r = 0.768, p = 0.016) between femoral neck BMD with DXA and total volumetric BMD(Tt.vBMD) at the distal tibia.

Conclusion: The bone health status of adult hemophilia patients in China is worrying. The occurrence of OP may be accompanied by varying degrees of bone loss, bone destruction, and structural abnormalities observed in both trabecular and cortical bones of the upper and lower limbs. The condition of the trabecular bones in the lower limbs is particularly severe. The correlation between BMD measurements obtained from HR-pQCT and DXA is strong.

Background: Periprosthetic joint infection leads to significant morbidity and mortality after total knee arthroplasty. Preoperative and perioperative risk prediction and assessment tools are lacking in Asia. This study developed the first machine learning model for individualized prediction of periprosthetic joint infection following primary total knee arthroplasty in this demographic.

Methods: A retrospective analysis was conducted on 3,483 primary total knee arthroplasty (81 with periprosthetic joint infection) from 1998 to 2021 in a Chinese tertiary and quaternary referral academic center. We gathered 60 features, encompassing patient demographics, operation-related variables, laboratory findings, and comorbidities. Six of them were selected after univariate and multivariate analysis. Five machine learning models were trained with stratified 10-fold cross-validation and assessed by discrimination and calibration analysis to determine the optimal predictive model.

Results: The balanced random forest model demonstrated the best predictive capability with average metrics of 0.963 for the area under the receiver operating characteristic curve, 0.920 for balanced accuracy, 0.938 for sensitivity, and 0.902 for specificity. The significant risk factors identified were long operative time (OR, 9.07; p = 0.018), male gender (OR, 3.11; p < 0.001), ASA > 2 (OR, 1.68; p = 0.028), history of anemia (OR, 2.17; p = 0.023), and history of septic arthritis (OR, 4.35; p = 0.030). Spinal anesthesia emerged as a protective factor (OR, 0.55; p = 0.022).

Conclusion: Our study presented the first machine learning model in Asia to predict periprosthetic joint infection following primary total knee arthroplasty. We enhanced the model's usability by providing global and local interpretations. This tool provides preoperative and perioperative risk assessment for periprosthetic joint infection and opens the potential for better individualized optimization before total knee arthroplasty.

Background: Intra-articular corticosteroid injection is commonly used for pain relief in ankle osteoarthritis (OA). The effects of corticosteroids (CS) are short-lived, whereas hyaluronic acid (HA) have longer-lasting effects. The objective was to compare the efficacy of dual injections of CS and HA to CS alone. We hypothesized that intra-articular injections of dual agents would be more effective than CS alone.

Methods: A single-blind, randomized, controlled trial was designed to investigate this hypothesis. 135 patients with ankle OA were enrolled into an intra-articular CS injection group (CS group, n = 61) or dual HA plus CS injection group (CS + HA group, n = 74). The CS group received 1 mL of corticosteroid and 1 mL of 0.5% bupivacaine and 1 mL of normal saline once, and the CS + HA group received 3 mL of a total of 5 mL mixtures containing 2 mL of HA, or 1 mL of corticosteroid, 0.5% bupivacaine, and normal saline in the first week, followed by 2 mL of HA in the second and third weeks. Clinical evaluations were performed before injection, 6 and 12 weeks after the first injections. The Ankle Osteoarthritis Scale (AOS) was used as the primary outcome measure, and the Visual Analogue Scale (VAS), Short Form Health Survey (SF-36), and complications were used as secondary outcomes.

Results: The mean AOS change from baseline was significantly greater in the CS + HA group than in the CS group at 6 (p ≤ 0.01) and 12 weeks (p ≤ 0.01). The mean VAS change from baseline was significantly greater in the CS group than in the CS + HA group at 6 weeks (p = 0.023), but not at 12 weeks (p = 0.731). The mean SF-36 change from baseline was not significant between the CS and CS + HA groups at 6 (p = 0.416) and 12 weeks (p = 0.215).

Conclusions: The combination of corticosteroid and HA injection is more effective than corticosteroid alone in relieving pain in ankle OA.

Trial registration: Clinical Research Information Service in South Korea, KCT0008690 // Registration Date (First Posted): July 21th, 2023 ( http://cris.nih.go.kr ).

Background: This study compared patient characteristics, clinical outcomes, and antibiotic durations between patients undergoing posterior fixation for gram-negative rods (GNR) or gram-positive cocci (GPC) thoracolumbar pyogenic spondylitis.

Methods: In this multicenter retrospective cohort study, 53 patients who underwent minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis were categorized into a GPC or GNR group based on the identified causative organisms. Patient characteristics, surgical outcomes, and postoperative infection control were compared between the two groups to identify factors affecting antibiotic duration.

Results: The patients in the GNR group (n = 14) were older (77.2 years versus 70.1 years; p = 0.008), had a higher incidence of a history of abdominal-pelvic infections (4 versus 0; p = 0.003), required longer preoperative antibiotics (5.9 weeks versus 3.0 weeks; p = 0.035), and had more unplanned additional surgeries due to poor infection control (n = 4 versus n = 1; p = 0.014) than those in the GPC group (n = 39). Furthermore, GNR infection independently predicted longer preoperative antibiotic duration (p = 0.002, β = 0.43).

Conclusions: Pyogenic spondylitis with GNR is associated with the need for prolonged antibiotic treatment and higher rates of unplanned additional surgeries due to poor infection control as compared to GPC-associated pyogenic spondylitis. Older age and a history of abdominal-pelvic infections tend to complicate the management in these patients; therefore, tailored treatment strategies are required to optimize treatment duration and minimize complications.

Clinical trial number: Not applicable.

Objective: To analyze the expression and determine the significance of cytokines in peripheral blood and vertebral blood in the bone microenvironment of patients with osteoporotic vertebral compression fractures (OVCFs) and Kummell's disease (KD).

Methods: From October 2022 to April 2023, 16 patients with osteoporotic vertebral compression fracture (OVCF), 14 patients with Kummell (KD) disease, and 19 patients with lumbar degenerative disease were included in the study. The patients were divided into the OVCF group, KD group and control group. The levels of interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and transforming growth factor-β (TGF-β) in peripheral blood and vertebral blood in the bone microenvironment were detected by enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curve analysis was used to determine the correlation between cytokines and the occurrence of OVCF and KD.

Results: The levels of IL-1, IL-6, TGF-β and TNF-α in vertebral blood in the bone microenvironment of the KD group were significantly higher than those in peripheral blood (p = 0.001, p < 0.001, p = 0.017, p < 0.001). Compared with the control group, the OVCF displayed a marked increase in the expression of IL-1, IL-6, and TNF-α and a significant reduction in the expression of TGF-β (p < 0.001). In addition, compared with the vertebral blood in the bone microenvironment of the control group, the levels of IL-1, IL-6 and TNF-α in the vertebral blood in the bone microenvironment of the KD group were significantly increased (p < 0.001). and compared with the vertebral blood in the bone microenvironment of OVCF group, the levels of IL-1, IL-6 and TNF-α in the vertebral blood in the bone microenvironment of the KD group were significantly increased (p = 0.014, p = 0.020, p = 0.006). Moreover, Compared to peripheral blood, the vertebral blood within the bone microenvironment demonstrated increased area under the curve (AUC) values for the associations of IL-1, IL-6, and TNF-α with OVCF and Kummell's disease KD.

Conclusions: The expression levels of IL-1, IL-6 and TNF-α in OVCFs and KD were increased, but that of TGF-β was decreased. The levels of IL-1, IL-6 and TNF-α in the vertebral blood of KD patients were significantly increased, which can promote vertebral osteonecrosis and bone nonunion in KD patients. Alterations in the expression levels of these proinflammatory cytokines maybe demonstrate a significant correlation with the pathogenesis of OVCF and KD.

Objective: This meta-analysis evaluates the efficacy and safety of various topical dosage forms of diclofenac (gel, solution, and patch) for the treatment of knee osteoarthritis.

Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science for randomized controlled trials evaluating topical diclofenac formulations in knee osteoarthritis patients. Data on pain relief, functional outcomes, and adverse events were extracted. The primary outcomes were pain and function scores at different follow-up intervals (1-2 weeks, 3-6 weeks, 8-12 weeks), and safety outcomes.

Results: A total of 12 randomized controlled trials (RCTs) were included in the analysis. Diclofenac gel, solution, and patch were all shown to significantly alleviate pain and improve function in patients with knee osteoarthritis. At 1-2 weeks, the diclofenac patch delivered the most pronounced short-term pain relief (SMD: -0.64; 95% CI: -0.90 to -0.39), while the gel and solution demonstrated sustained efficacy over the mid-term (3-6 weeks) and long-term (8-12 weeks). whereas skin-related adverse events, systemic side effects and withdrawal rates remained low across all formulations. The overall quality of evidence was assessed as moderate to high, reinforcing the robustness of the findings.

Conclusions: Topical diclofenac formulations (gel, solution, patch) significantly improve pain and function in knee osteoarthritis compared to placebo. All formulations were well-tolerated, with no significant increase in adverse events. These findings support the use of topical diclofenac for short-term pain relief and functional improvement in KOA patients.

Purpose: Postmenopausal female patients with a history of a single hip fracture are at higher risk of a second fracture. The poorer clinical outcomes of this patient group warrants evaluating the risk of experiencing a second hip fracture. Therefore, this study aimed to investigate the effectiveness of hip structural analysis (HSA) in assessing the risk of second hip fracture in postmenopausal females.

Methods: This retrospective analysis included 188 patients selected from the Chinese Second Hip Fracture Evaluation (ClinicalTrials.gov identifier: NCT03461237, first registration/posted date: 09/03/2018). They were divided into the second hip fracture (35 cases, with a mean age of 79.33 ± 7.70 years) and the control group (153 cases, with a mean age of 73.41 ± 9.56 years). Parker Mobility Score were determined via telephone follow-up, and two computed tomography scanners were used for images acquisition. All HSA and areal bone mineral density (aBMD) parameters were calculated through Mindways QCTPRO software.

Results: The refracture group showed increased age, decreased cross-sectional area, total hip aBMD, trochanteric aBMD, and intertrochanteric aBMD (p < 0.05). Total hip and intertrochanteric aBMD have a protective effect on the occurrence of a second hip fracture in postmenopausal women, with odd ratios of 0.61 and 0.57, respectively (p < 0.05). Incorporating HSA parameters into the baseline model (used age, type 2 diabetes mellitus, and the PMS as parameters, AUC = 0.729) does not significantly improve the performance of second hip fracture prediction (AUC = 0.748, p < 0.05 in Delong's test).

Conclusion: Based on our findings, HSA does not statistically correlate with the incidence of second hip fracture in postmenopausal women. Incorporating HSA parameters into the (baseline) model does not significantly improve the pridictive capabilities.

Background and objectives: Hemodialysis (HD) patients struggle with musculoskeletal disorders. This study aimed to examine knee clinical and musculoskeletal ultrasonographic (MSUS) characteristics in HD patients and to evaluate the influence of age, gender, and HD duration.

Materials and methods: This cross-sectional descriptive study included 52 patients (104 knee joints) on regular HD for at least 6 months. Demographic, clinical, therapeutic, and laboratory data were collected. Chronic knee pain was assessed for duration, intensity, and laterality. Swelling, crepitus, and tenderness were assessed in both knees. EULAR-standardized knee MSUS evaluations were performed on all patients. The patients were then compared based on age, gender, and HD duration.

Results: The mean age of the patients was 52.4 ± 14.15 years, with 25 females and 27 males, median duration of HD was 3.5 years. Chronic knee pain was present in 31 of 104 knees (29.8%). The scanned 104 knee joints had at least one MSUS finding in 91 (87.5%): suprapatellar effusion in 57 (54.8%), synovial thickening in 13 (12.5%), abnormal cartilage morphology in 68 (65.4%), quadriceps tendon abnormalities in 58 (55.8%), patellar tendon abnormalities in 34 (32.7), medial meniscus abnormalities in 30 (28.8%), lateral meniscus abnormalities in 13 (12.5%), and Baker cyst in 5 (4.8%). MSUS abnormalities were significantly more prevalent in HD patients older than 40 years (94.9% vs. 65.4; p < 0.001). Chronic Knee Pain was more prevalent in females than males (40% versus 20%, respectively). Regarding HD duration, quadriceps, and patellar tendons exhibited more MSUS abnormalities in patients with HD duration > 3 years (86.5% vs. 42.0% and 38.9% vs. 25%, respectively) compared to others.

Conclusion: MSUS findings of the knee are prevalent among HD patients, particularly those of female gender, older age, and longer duration of HD. These findings could be subclinical. Typically, the severity of suprapatellar effusion is related to additional structural abnormalities.