BMC Musculoskeletal Disorders最新文献

Background: This study aimed to evaluate the accuracy and reproducibility of a newly developed portable and radiation-free three-dimensional spine sensing system (3D-SSS) for scoliosis assessment.

Methods: A total of 145 patients underwent full-spine imaging using the EOS imaging system, and 3D-SSS data were collected between February 2023 and April 2023. A radiologist used sterEOS software to reconstruct the spine in 3D and obtain the Cobb angle. One radiologist and one orthopedist independently measured the patients using 3D-SSS, with the orthopedist performing two measurements per patient. The 3D-SSS post-processing system automatically generated the Cobb angle.

Results: The mean Cobb angles obtained from EOS and 3D-SSS were 13.7 ± 9.9° (0.5∽45.7°) and 12.5 ± 8.6° (0.4∽40°), respectively. The intraclass correlation coefficient (ICC) for reliability between EOS and 3D-SSS was 0.921, indicating excellent agreement. Bland-Altman analysis revealed a bias of -1.171° between EOS and 3D-SSS, with only 10 patients outside the limits of agreement (-8.3∽6.0°). The root mean square error between EOS and 3D-SSS was 3.2°. A strong correlation was observed between the Cobb angles measured by EOS and 3D-SSS (r = 0.931, P < 0.001). The receiver operating characteristics curve showed that the diagnostic performance of 3D-SSS for scoliosis was 0.953 (P < 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of 3D-SSS for diagnosing scoliosis were 87.8%, 92.1%, 93.5%, and 85.3%, respectively. The intraobserver and interobserver ICCs for Cobb angles derived from 3D-SSS were 0.969 and 0.934, respectively, demonstrating excellent reproducibility.

Conclusions: The portable and radiation-free 3D-SSS accurately measured scoliosis and provided highly reproducible data. This system offers a novel method for clinicians to screen and monitor scoliosis in young patients.

Background: The flexor pronator mass (FPM) is an important dynamic stabilizer to valgus stress at the elbow and has been reported to protect against ulnar collateral ligament (UCL) injury. Active gripping and pronation have demonstrated reduced ulnohumeral joint space and change in material properties of the UCL when examined in vivo via ultrasound. No studies have utilized ultrasonography and shear wave elastography to characterize the medial elbow's response to FPM activation under valgus stress. This cross-sectional, repeated measures study aims to characterize medial elbow changes in UCL and FPM tissue stiffness and joint space width (JSW) during valgus stress with incremental FPM activation through gripping.

Methods: Thirteen participants (6 male, 7 female) aged 18-40 year with a BMI < 30 and no history of upper extremity injury were included in this study. Elbows were placed in a telos stress device at 30° of flexion and a 100N valgus stress was applied. Participants then activated the FPM by gripping a spherical dynamometer at 100, 75, 50, 25, and 0% of maximal grip strength. UCL thickness, ulnohumeral (UH) JSW, UCL stiffness, and FPM stiffness were measured for each condition and compared via a two-way repeated measures ANOVA and a post hoc Fischer's Least Significant Difference test.

Results: Men and women showed no baseline differences in UCL thickness or UH JSW. JSW was significantly wider under valgus load, 2.22 ± 0.42 mm vs. 2.99 ± 0.46 mm in males and 2.15 ± 0.41 mm vs. 2.99 ± 0.55 mm in females (p < 0.05). No statistically significant differences were demonstrated in UH JSW by gripping force magnitude and differences by sex were not observed. Additionally, no significant changes in tissue stiffness were observed during dynamic conditions for shear wave velocities for either the UCL or FPM.

Conclusion: Gripping does not change UH JSW or medial elbow tissue stiffness in the joint testing configuration and external loading conditions applied in this study. This suggests that gripping may not be as protective during the high valgus stress observed in baseball pitching as believed, and that the influence of FPM activity may be joint position or load dependent.

Objective: Osteoarthritis (OA) causes significant musculoskeletal pain. This study assessed the efficacy and safety of fasinumab, an investigational nerve growth factor inhibitor, in patients with moderate-to-severe OA pain of the knee/hip.

Methods: In this Phase 3, randomized, double-blind, placebo- and non-steroidal anti-inflammatory drug (NSAID)-controlled study, patients with OA (Kellgren-Lawrence grade ≥ 2; Western Ontario and McMaster Universities Arthritis Index [WOMAC] pain score ≥ 4) received (2:1:1:1) fasinumab 1 mg every 4 weeks, diclofenac 75 mg twice daily, celecoxib 200 mg daily, or placebo for 24 weeks. Co‑primary endpoints were change in WOMAC pain and physical function scores to Week 24 versus placebo. For safety, joints were imaged in all patients at pre‑specified times, regardless of symptoms.

Results: Of 4531 patients screened, 1650 were randomized. At Week 24, greater improvements were observed for fasinumab versus placebo; least-squares mean difference: -0.63 (p = 0.0003) for WOMAC pain and -0.64 (p = 0.0003) for physical function. Improvements were numerically greater for fasinumab versus NSAIDs for physical function (-0.64 versus -0.31; nominal p < 0.05) and pain (-0.63 versus - 0.39; p = NS). Adjudicated arthropathies occurred in 1.6% of placebo-treated, 1.5% of NSAID-treated, and 5.6% of fasinumab-treated patients; joint replacements occurred in 3.6% of placebo-treated, 4.8% of NSAID-treated, and 3.4% of fasinumab-treated patients.

Conclusion: Fasinumab significantly improved WOMAC pain and physical function scores versus placebo in < 24 weeks in difficult-to-treat patients with pain due to OA of the knee/hip. Adjudicated arthropathies were more frequent with fasinumab; there were no differences in the proportions of patients with joint replacements.

Trial registration: Clinicaltrials.gov NCT03304379. Date of first registration: October 2, 2017.

Background: Serum alkaline phosphatase (ALP) plays a crucial role in bone and muscle health. Previous studies have demonstrated that serum alkaline phosphatase (ALP) is closely associated with muscle mass. Nevertheless, the association between serum alkaline phosphatase (ALP) and grip strength remains unclear. Therefore, the present study focused on exploring the association of serum ALP with grip strength in middle-aged and elderly people.

Methods: We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey conducted from 2011 to 2014. A total of 3514 participants (1891 males and 1623 females) aged 40-80 years were included in this study. Serum ALP and pelvic grip strength were analyzed as independent and dependent variables, additional variables were the possible impact modifiers. weighted generalized linear models and stratified analysis by gender, age group, and race were applied to assess the relationship between serum ALP and grip strength. Smooth curve fitting and threshold effect analysis/saturation effect analysis were used to analyze the nonlinear relationship between the 2 variables.

Results: In the gender-stratified subgroup analysis, we observed an inverse association between serum ALP and grip strength in both male and female. When stratified by age group, the association remained significant among participants 40-59 years of age, but not among those ≥ 60 years old. When stratified by race, the association remained significant among Non-Hispanic White and Non-Hispanic Black. It is noteworthy that serum ALP and grip strength showed a significant negative correlation among female aged 40-59 years, but not among female aged ≥ 60 years. Additionally, Smooth curve fitting showed that serum ALP had a nonlinear relationship with grip strength in male aged 40-59 years and male aged over 60 years, the inflection points are 54 IU and 97 IU respectively.

Conclusion: Our study revealed an inverse relationship between serum ALP and grip strength, this finding offers new insights and avenues for understanding how serum alkaline phosphatase affects skeletal muscle health.

Background: Pain is pivotal in managing knee osteoarthritis (KOA), necessitating tailored rehabilitative strategies. The biopsychosocial framework suggests that a multifaceted approach is crucial for understanding and managing pain in KOA patients. This study explored the factors that influence pain intensity through biological and psychosocial determinants from a biopsychological perspective in KOA patients.

Methods: This cross-sectional study included 150 KOA patients with Kellgren-Lawrence (K/L) grades 2-4. Patients were classified into three groups based on their Visual Analogue Scale scores: mild (n = 79), moderate (n = 40), and severe pain intensity (n = 31). The biological determinants included the body mass index, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for knee function, the 30-second sit-to-stand (30STS) test for functional strength, and the Timed-Up and Go (TUG) test for mobility. Psychological determinants comprised the Depression Anxiety Stress Scale-21 (DASS-21) for emotional well-being, the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia, and the Activities-Specific Balance Confidence (ABC) scale for balance confidence. Social determinants included educational attainment and the Short Form-36 (SF-36) for health-related quality of life.

Results: Significant differences in biopsychosocial determinants were identified among the various pain intensity groups. Biological factors, including WOMAC scores, TUG, and 30STS tests; psychological factors, such as depression and anxiety (DASS-21) and kinesiophobia (TSK); and social factors, including mean years of education and all SF-36 subscales, were significantly worse in the severe pain group (p < 0.05). However, balance confidence did not differ between groups (p = 0.060). Patients in the severe pain group exhibited poorer outcomes across biological, psychological, and social domains, whereas the moderate pain group displayed worse biological and social outcomes when compared to the mild pain group (p < 0.05).

Conclusion: This study emphasizes the significance of a biopsychosocial framework in managing pain in KOA patients. Worsened biological factors like knee function, mobility, and functional strength, alongside psychological issues such as depression and anxiety, influence pain intensity. Social determinants, including lower educational attainment and quality of life, highlight the need for patient-centered care. Future research should include diverse populations and longitudinal data to improve interventions and guide global health policies for integrating the biopsychosocial perspective for KOA management.

Background: Trifocal bone transport (TF) rather than bifocal bone transport (BF) can shorten the treatment time when treating of large bone defect in tibia. However, few studies have reported efficacy and complications among different bone transport.

Aim: To evaluate the effectiveness and complications of bone transport technique for the treatment of large bone defect in tibia.

Methods: The retrospective study including 48 patients who underwent bone transport for the treatment of large bone defect in tibia from May 2015 to September 2019. A total of 30 were treated by bifocal bone transport (BF group) and 18 by trifocal bone transport (TF group). Patient demographic data, intraoperative outcomes, postoperative variables, complications and clinical outcomes of the two groups were recorded and compared at a minimum follow-up of 24 months. Postoperative complications were also evaluated according to Paley classification. Based on the Association for the Study and Application of Methods of Ilizarov (ASAMI) standard, the bone and functional results were evaluated at the last clinical follow-up.

Results: All patients with an average follow-up of 27.5 months. All patients achieved complete union in the docking site and consolidation in the regenerate bone. Compared to the BF group, the TF group had a longer bone defect length(9.08 ± 1.74 > 6.33 ± 3.15, P < 0.01) but a shorter external fixation index (42.22 ± 2.41 < 65.82 ± 6.98, P < 0.001). The mean number of complications per patient was 1.6 and 1.7 for BF and TF patients (P > 0.05). At the postoperative follow-up, there were no significant differences between the 2 groups in the bone and functional results (P > 0.05).

Conclusion: For tibial bone defects, both bifocal and trifocal bone transport can achieve good clinical results. Compared to the bifocal bone transport, The trifocal bone transport can significantly shorten the external fixation index without increasing the incidence of associated complications.

Background: Systematic inflammation plays an important role in the pathogenesis of osteoporosis. Neutrophil to high-density lipoprotein cholesterol ratio (NHR) has been considered as a novel inflammatory marker. To date, the clinical association between NHR and fragility fracture is not yet well-known. Thus, the present study explored whether NHR levels in patients with osteoporosis were associated with an increased risk of fragility fracture.

Methods: This case-control study included 271 osteoporotic patients with and without a history of fragility fracture from January 2017 to December 2021. Laboratory tests and physical examinations were conducted in all participants, and NHR was calculated.

Results: The mean NHR levels in patients with fragility fractures were significantly higher compared to those without fragility fractures (2.91 ± 1.18 vs. 2.21 ± 0.91, P < 0.001). Additionally, there was a significant positive correlation between NHR and fragility fracture (r = 0.310, P < 0.001). Moreover, we could detect a statistical increment of the area under receiver operating characteristics curve (from 0.681 to 0.805, P < 0.001) upon the combination of NHR and Fracture Risk Assessment Tool (FRAX) score for determining the presence of fragility fracture among the study patients. In multivariable logistic regression models, elevated NHR level was an independent risk factor for fragility fracture (adjusted OR: 1.924, 95% CI: 1.443-2.564, P < 0.001) when adjusted for alkaline phosphatase and FRAX score.

Conclusions: As a valuable and convenient inflammatory biomarker calculated from routine blood examinations, NHR might help to identify individuals with osteoporosis who are at high risk of fragility fracture.

Background: Chronic permenant lateral patellar dislocation is a rare, complex condition that affects an adult's entire lower extremity and may cause functional impairment. This study aimed to identify single-stage surgery for functional recovery in patients and to assess the radiological and functional outcomes of our technique, particularly concerning patellofemoral osteoarthrosis, at mid-term follow-up.

Methods: The study retrospectively analyzed eight patients with eleven afflicted knees who had our novel surgical method, termed the all-in-one treatment, from 2011 to 2017. The average follow-up duration was 11.3 years, with a range of 6 to 12 years. An analysis was conducted on the files of patients who satisfied the specified criteria. Data, comprising questionnaires, clinical examinations, radiographs, and functional assessments, were recorded. All patients underwent assessments of the lateral patellofemoral angle, compliance angle, Iwano classification, sulcus angle, and Wiberg-Patellar type. We classified all patients according to the Outerbridge chondromalacia classification, and conducted additional clinical assessment using the Kujala et al. patellofemoral impairment score.

Results: All patients experienced functional improvement, with a mean preoperative Kujala score of 40.89 and a mean postoperative Kujala score of 68.3. No instances of bone nonunion, skin necrosis, or periprostatic fractures were identified in our investigation. No significant degenerative alterations were observed on tomography throughout follow-up, except in one patient who had undergone trochleoplasty. During the postoperative period, no patient experienced any instability.

Conclusion: Our study's primary finding is that the functional gain of knees with chronic dislocations, on which we performed our surgical approach, demonstrated a significant long-term improvement. However, further research is needed to compare single-stage and multi-stage treatments and to assess the long-term outcomes of these treatments and the associated risk of patellafemoral osteoarthritis, re-dislocation, and loss of functional gain.

Background: Childhood abuse has been linked to poorer health outcomes in individuals with fibromyalgia (FM), and this relationship may be affected by cognitive processes such as pain catastrophizing and mindfulness.

Objective: This study investigated the impact of childhood abuse on pain-related symptoms and functioning in individuals with (FM) and examined how the critical psychosocial constructs of pain catastrophizing and mindfulness might moderate this relationship. We hypothesized that childhood abuse would be linked to greater physical symptoms and lower functioning, with pain catastrophizing and mindfulness influencing these associations.

Methods: The study sample consisted of 113 women with FM. Correlational analyses were conducted to examine the relationship between childhood abuse and health outcomes (pain severity, pain interference, fibromyalgia impact, and physical functioning). Moderation analyses were conducted to examine the impact of pain catastrophizing and mindfulness on the relationship between childhood abuse and health outcomes.

Results: As expected, catastrophizing was generally associated with elevated pain-related symptomatology and reduced functioning, and higher levels of mindfulness were associated with reduced pain impact. However, contrary to our hypothesis, childhood abuse was not directly associated with pain severity, pain interference, fibromyalgia impact, or physical functioning. Pain catastrophizing and mindfulness were significant moderators of the relationship between childhood abuse and health outcomes. Specifically, childhood abuse was related to higher pain interference only at low levels of catastrophizing and was associated with greater fibromyalgia impact and reduced physical functioning only at high levels of mindfulness.

Conclusion: Our findings suggest that while childhood abuse did not directly impact pain-related outcomes in this sample of fibromyalgia patients, cognitive factors like pain catastrophizing and mindfulness play significant roles in moderating these effects. These results underscore the importance of assessing for cognitive and psychological factors in the management of fibromyalgia, especially for patients with a history of childhood abuse. Further research is needed to explore these relationships in more diverse samples and to develop personalized and targeted interventions for this patient population.

Objective: To evaluate the effectiveness and cost-effectiveness of physiotherapy, chiropractic care, and the combination of physiotherapy and chiropractic care compared with information and advice for the treatment of patients with nonspecific chronic low-back pain (CLBP) in Sweden.

Design: A multicentre pragmatic randomized controlled trial.

Setting: Ten primary care rehabilitation units in Sweden.

Participants: Eighty-eight participants with nonspecific CLBP.

Interventions: The participants were randomly assigned to receive physiotherapy, chiropractic care, combination treatment, or information and advice.

Main outcome measures: This study measured the Oswestry Disability Index (ODI), health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), working status, and costs.

Results: The study revealed no statistically significant differences in any of the outcome measures when physiotherapy, chiropractic care, and combination treatment with information and advice were compared (p > 0.05). The ODI changes between baseline and the 6-month follow-up ranged from 6.13 to 12.56 across the treatment groups, indicating reduced disability in all groups. Compared with the other treatment options, the combination treatment resulted in the greatest QALY gain (0.418) and lowest cost (SEK 3,081).

Conclusion: Compared with alternative standalone treatment options, the combination treatment strategy resulted in greater QALY gain and lower costs from a heath care perspective. Although the study did not detect statistically significant differences in outcomes or costs among the treatment options, the combination treatment showed promising potential for cost-effectiveness. Given the small sample size and low statistical power of the study, further clinical trials with fewer treatment arms and a focus on the combination group are warranted to confirm these findings. The insights gained from this study are important for informing the design and conduct of future clinical studies investigating the effectiveness, costs and cost-effectiveness of treatments for CLBP.

Trial registration: The study is registered in the ISRCTN registry (2017-02-20: ISRCTN15830360).