BMC Musculoskeletal Disorders最新文献

Background: High-level complete transection of the median nerve will impair the flexion function and sensation of the thumb and index finger, and will also result in weakened wrist flexion strength. In rare cases, atypical clinical manifestations may arise, potentially due to ulnar-to-median nerve anomalies, such as Marinacci communication (MC), or the function of muscles directly innervated by ulnar nerve branches.

Case presentation: A 52-year-old male sustained a chainsaw injury to his left elbow and forearm, resulting in complete transection of the median nerve. Despite this, he retained partial finger flexion, with muscle strength reaching grade IV in the 3rd-5th fingers on postoperative day one. Marinacci communication, a rare anatomical variant, may explain the preserved motor function in the absence of direct nerve continuity. Electrophysiological studies are key to diagnosing MC, which can influence recovery after nerve injuries. In this case, preserved flexion function suggests the presence of MC. Greater awareness and understanding of this communication are essential for accurate diagnosis and treatment planning.

Conclusion: There exists a low-probability anatomical variation in the forearm concerning the ulnar and median nerves. This case contributes further to our understanding of the clinical presentation of hand function following high median nerve transection. It also provides valuable evidence for further exploration of the physiological aspects of never communication.

Background: Coccygectomy is the definitive treatment of coccygodynia refractory to conservative therapy, but post operative wound infection poses a significant challenge in these patients. We introduce a novel peri-operative technique incorporating a specific pre-operatively dietary regimen, polyethylene glycol enema, and prophylactic antibiotics. Post-operatively, patients adhered to strict hygienic protocols in addition to receiving antibiotics. This technique successfully reduced the incidence of surgical site infection post coccygectomy to a rate of 0.0%.

Methods: A retrospective review was conducted on 21 patients who underwent partial or complete coccygectomy for coccygodynia refractory to 6 months of conservative therapy. Patients were treated using our novel protocol to minimize the infection risk and significant improvement in their pain.

Results: All of the patients experienced uneventful post operative recovery except for 1 solitary case of delayed wound healing. This case was treated with a silver impregnated dressing and demonstrated full wound recovery 1 week later. Additionally, pain scores showed a significant reduction of pain before and after surgery. These results highlight the efficacy of our enhanced peri-operative protocol in preventing surgical site infection as well as substantial pain relief.

Conclusion: Our findings are consistent with the existing literature, demonstrating that an enhanced peri-operative protocol not only effectively prevents post-operative infections but also facilitates significant pain relief in patients undergoing coccygectomy. This novel peri-operative protocol may offer a new standard for managing post-surgical outcomes in coccygectomy, though prospective studies are needed to further validate these results.

Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal problems worldwide. Even though regular exercise is recommended as the primary conservative approach in treating this condition, significant part of patients lead sedentary lifestyle. Motivation to exercise is one of the variables that effects the adherence of exercise-based treatments. This study aimed to characterize the motives for exercise, as posited by self-determination theory, in persons with CLBP, and to identify subgroups (clusters) of motivational profiles in combination with socioeconomic and clinical characteristics using k-means cluster analysis.

Methods: Data were collected between September 2022 and September 2023. A total of 103 adults with CLBP completed the paper-pencil Exercise Self-Regulation Questionnaire (SRQ-E) and provided self-reported measures on anthropometric and socio-economic characteristics. Inclusion criteria were age (≥ 18 years) and non-specific CLBP (lasting longer than 12 weeks). Exclusion criteria included specific lumbar spine pathology (e.g., fracture, cancer), worsening neurological symptoms, recent injection therapy (within 3 months), and current alcohol or drug misuse.

Results: Three distinct motivational clusters were identified among the 103 participants: two clusters were characterized by predominantly autonomous motivation (moderately motivated cluster: 31.1%; highly motivated cluster: 54.4%), while one cluster (controlled convinced cluster: 14.6%) showed a higher level of controlled motivation. Associations were observed between the controlled cluster and factors such as higher disability scores, longer duration of pain, greater number of completed physiotherapy sessions, and elevated BMI. Notably, the controlled motivation cluster was linked with poorer clinical outcomes.

Conclusions: This study provides insights into the exercise motivation of patients with CLBP, revealing that while most patients were primarily autonomously motivated, a notable subgroup exhibited lower, controlled motivation. The presence of controlled motivation was associated with worse functioning, longer pain duration, and increased utilization of physiotherapy services. Although these findings suggest a link between motivational profiles and clinical outcomes, the cross-sectional design limits causal inferences. Further research is needed to explore these relationships longitudinally.

Trial registration: ClinicalTrials.Gov Identifier: NCT05512338 (22.8.2022, NCT05512338).

Background: Prehabilitation involving a planned exercise program before surgery is proposed to improve rehabilitation and postoperative outcomes. However, the current evidence on the efficacy of prehabilitation for patients awaiting total hip replacement is conflicting. The aim of this study was to evaluate efficacy of preoperative exercises and education (AktivA®) for adults 70 years or older awaiting total hip replacement.

Methods: In a two-armed randomized controlled trial we recruited 98 participants aged 70 years or older with a Harris Hip Score less than 60 awaiting elective primary total hip replacement. Participants were recruited at three hospitals in Norway between 2019 and 2022. Participants were randomly assigned to prehabilitation or usual care. The prehabilitation group received a tailored exercise program for 6-12 weeks in addition to patient education. Gait speed, the primary outcome, was measured by the 40 m Fast-Paced Walk Test. Secondary outcomes included performance-based tests (Chair Stand Test, Timed Up & Go Test, 6-Minute Walk Test, Stair Climb Test) and patient-reported outcomes (Hip Disability and Osteoarthritis Outcome Score (HOOS) and EQ-5D). Outcomes were assessed at baseline, post intervention, and further 6 weeks, 3-, 6-, and 12 months post-surgery.

Results: For the primary outcome gait speed at the primary endpoint (3 months post-surgery), no significant between-group differences were observed. However, post-intervention (before surgery), we found a significant improvement in favor of prehabilitation for both gait speed (0.15 m/s, 95% CI 0.02-0.28) and the HOOS quality of life subscale (11.93, 95% CI 3.38-20.48). No other significant differences were found at any post-surgery follow-up for these outcomes. For other secondary outcomes, there were no between-group differences at any point of assessment. Both groups showed improvement across all outcomes 3-12 months after surgery.

Conclusions: The AktivA^®program, used as a prehabilitation intervention during a period of 6-12 weeks before total hip replacement did not improve gait speed or any other post-operative outcomes compared to usual care. Both groups demonstrated significant improvement in gait speed and performed well relative to Western reference values 12 months post-surgery. Thus, replacing painful hip joints through total joint replacement seems to outweigh the efficacy of prehabilitation.

Trial registration: ClinicalTrials.gov Identifier: NCT03602105-initial release: 06/06/2018.

Objective: This study aimed to explore whether total hip arthroplasty (THA) aided by full-process robotics was effective in patients undergoing developmental dysplasia of the hip (DDH).

Methods: Totally 112 patients were enrolled and classified into robotic-assisted group (n = 56) and the conventional group (n = 56). In addition, retrospective analysis was used for comparing the difference in therapeutic efficacy.

Results: A total of 112 patients received THA, and were followed up for (12.78 ± 0.76) months on average, with no occurrence of associated complications. For patients in robot-assisted group, their abduction and anteversion angles of acetabular cup placement were in the safe zone, while those in 8 patients of the conventional group were outside the safe zone. Compared to the conventional group, the robot-assisted group had higher postoperative Harris Hip Score and FJS, whereas lower VAS score.

Conclusion: Robot-assisted THA is advantageous in terms of both intraoperative precision and postoperative effect on the treatment of patients with DDH.

Background: Carbon-fiber-reinforced polyether ether ketone (CF-PEEK) is a radiolucent, non-metallic implant material used for instrumented lumbar spondylodesis. Clinical studies of pedicle screw systems employing this material, especially for degenerative indications, are scant.

Methods: We conducted a multicenter, prospective clinical study to assess clinical and radiographic outcomes in patients with symptomatic degenerative lumbar disk disease, including degenerative spondylolisthesis treated with a CF-PEEK pedicle screw and a transforaminal lumbar interbody fusion (TLIF) cage system. We followed up the participants for two years postoperatively to collect clinical data (via the Oswestry Disability Index, Core Outcome Measures Index, and Visual Analog Scale), radiographic parameters (functional X-rays) to assess fusion status, and any complications.

Results: In total, 86 patients were recruited. During the study, 21 patients (24.4%) dropped out, including 5 (5.8%) who underwent explantation of the study device(s). At the final follow-up, the fusion rate was 98.6% (95% confidence interval, 92.7-100.0%). All clinical parameters improved significantly. There were no complications potentially attributed to the implant material.

Conclusions: The results demonstrate a fusion rate similar to that of metallic implant systems with the use of a CF-PEEK pedicle screw and a TLIF cage system. Further studies with larger samples are needed to substantiate this finding.

Trial registration: The study was registered at ClinicalTrials.gov (NCT02087267). Date of registration: March 12, 2014.

Purpose: To estimate the health-related quality of life (HRQoL) of knee osteoarthritis outpatients in China overall and by body mass index (BMI), and to explore the factors associated with knee osteoarthritis.

Method: This was a cross-sectional study in which outpatients with knee osteoarthritis were recruited from three tertiary hospitals in China from June 2020 to May 2021. The EuroQoL five-dimensional instrument was used to measure HRQoL. Descriptive analysis, one-way analysis of variance, and a Tobit regression model were performed.

Results: One thousand and eight questionnaires were distributed, and nine hundred and fifty-two participants were included. The mean age was 61.71 years, and 61.03% of the participants were female. The mean health utility was 0.751 (95% CI 0.737, 0.765). The health utility varied significantly according to BMI: underweight = 0.627 (95% CI 0.536, 0.719), normal = 0.764 (95% CI 0.744, 0.784), overweight = 0.755 (95% CI 0.733, 0.776), and obese = 0.728 (95%CI 0.681, 0.776). Additionally, outpatients with knee osteoarthritis who were younger, had received treatment in the past six months, and had a disease duration shorter than 2 years had significantly higher HRQoL scores.

Conclusion: The HRQoL of knee osteoarthritis outpatients was considerably impaired and was significantly associated with BMI. These findings emphasize the importance of weight examination and management in outpatients with knee osteoarthritis for healthcare providers. Supplementary data were provided for public health-related policies and health economics studies, contributing to the development of effective management strategies and increasing the breadth of knowledge of HRQoL in outpatients with knee osteoarthritis.

Objective: To evaluate the effectiveness of using dorsal toe fibula composite flaps and iliac bone in sequential transplantation for the comprehensive reconstruction of fingers with grade I to III defects.

Methods: Between December 2020 and March 2024, data were collected from 36 patients who received complete finger reconstruction for grade I to III defects using dorsal toe fibula composite flaps and iliac bone in sequential transplantation. Postoperative evaluations included Carroll's hand function test scores, hand mobility disability assessments, and overall postoperative conditions.

Results: Postoperatively, Carroll's hand function test scores for patients with grade III finger defects showed a significant improvement (P < 0.05), while hand mobility disability scores significantly decreased (P < 0.05). All 47 finger defects in 36 patients were successfully reconstructed with favorable survival outcomes. Among these, two patients with grade III defects experienced donor site numbness; one reported minor walking difficulties, and the other had restricted mobility. Additionally, one case of infection occurred at the recipient site in a grade I defect patient and another at the donor site in a grade II defect patient. Both infections improved with appropriate dressings and cleaning. Overall, the recipient areas healed well, with 32 patients satisfied with the appearance, 4 finding it average, resulting in an 88.89% satisfaction rate. The donor sites also healed well in 33 cases, with 3 cases showing slow healing-one with a grade II and two with grade III defects-none of which developed hypertrophic scars. Of these, 29 patients were satisfied with the appearance, 5 found it average, and 2 were dissatisfied, leading to an 80.56% satisfaction rate for the donor sites.

Conclusion: The use of dorsal toe fibula composite flaps and iliac bone in sequential transplantation proves effective for fully reconstructing fingers with grade III defects, while minimizing the impact on both the appearance and function of the donor site.

Background: Measurement of Cobb angle in the frontal plane from radiographs is the gold standard of quantifying spinal deformity in adolescent idiopathic scoliosis (AIS). As a radiation free alternative, ultrasonography (USG) for quantitative measurement of frontal cobb angles has been reported. However, a systematic review and meta-analysis on the reliability of ultrasound comparing with the gold standard have not yet been reported.

Objectives: This systematic review and meta-analysis aimed to evaluate (1) the reliability of ultrasound imaging compared with radiographs in measuring frontal cobb angle for screening or monitoring in AIS patients; (2) whether the performance of USG differ when using different anatomical landmarks for measurement of frontal cobb angles.

Methods: Systematic search was performed on MEDLINE, EMBASE, CINAHL, and CENTRAL databases for relevant studies. QUADAS-2 was adopted for quality assessment. The intra- and inter-rater reliability of ultrasound measurement in terms of intra-class correlation coefficient (ICC) was recorded. Mean Absolute Difference (MAD) and Pearson correlation coefficients between frontal cobb angle measured from USG and radiographic measurements, were extracted with meta-analysis performed.

Results and discussion: Nineteen studies were included with a total of 2318 patients. The risk of bias of included studies were unclear or high. Pooled MAD of frontal cobb angle measured between USG and radiography was 4.02 degrees (95% CI: 3.28-4.76) with a pooled correlation coefficient of 0.91 (95% CI: 0.87-0.93). Subgroup analyses show that pooled correlation was > 0.87 across using various USG landmarks for measurement of frontal cobb angles. There was a high level of heterogeneity between results of the included studies with I² > 90%. Potential sources of heterogeneity include curve severity, curve types, location of apex, scanning postures, patient demographics, equipment, and operator experience. Despite being the "gold standard", intrinsic errors in quantifying spinal deformities with radiographs may also be a source of inconsistency.

Conclusion: The current systematic review indicated that there is evidence in favor of using USG for quantitative evaluation of frontal cobb angle in AIS. However, the quality of evidence is low due to high risk of bias and heterogeneity between existing studies. Current literature is insufficient to support the use of USG as a screening and/or follow-up method for AIS. Further investigation addressing the limitations identified in this review is required before USG could be adapted for further clinical use.