Fostering tissue engineering and regenerative medicine to treat musculoskeletal disorders in bone and muscle

The musculoskeletal system,which is vital for movement,support,and protection,can be impaired by disorders such as osteoporosis,osteoarthritis,and muscular dystrophy.This review focuses on the advances in tissue engineering and regenerative medicine,specifically aimed at alleviating these disorders.It explores the roles of cell therapy,particularly Mesenchymal Stem Cells(MSCs)and Adipose-Derived Stem Cells(ADSCs),biomaterials,and biomolecules/external stimulations in fostering bone and muscle regeneration.The current research underscores the potential of MSCs and ADSCs despite the persistent challenges of cell scarcity,inconsistent outcomes,and safety concerns.Moreover,integrating exogenous materials such as scaffolds and external stimuli like electrical stimulation and growth factors shows promise in enhancing musculoskeletal regeneration.This review emphasizes the need for comprehensive studies and adopting innovative techniques together to refine and advance these multi-therapeutic strategies,ultimately benefiting patients with musculoskeletal disorders.

Associations between Geriatric Nutrition Risk Index,bone mineral density and body composition in type 2 diabetes patients

BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.

Disruption of bone and skeletal muscle in severe burns

Severe burn injury triggers the body＇s nonspecific adaptive responses to acute insult, including the systemic inflammatory and stress responses, as well as the sympathetic response to immobilization. These responses trigger inflammatory bone resorption followed by glucocorticoid-induced apoptosis of osteoblasts and probably osteocytes. Because these patients are catabolic, they suffer concomitant muscle wasting and negative nitrogen balance. The use of anabolic agents such as recombinant human growth hormone and oxandrolone results in improved bone mineral content and muscle strength after approximately I year. Use of bisphosphonates within the first 10 days of a severe burn completely blocks the resorptive bone loss and has the added advantage of appearing to preserve muscle protein from excessive breakdown. The mechanism for the protective effect on muscle is not currently known. However, if the effect of bisphosphonates on muscle can be confirmed, it raises the possibility that bone communicates with muscle.

Administration of soluble activin receptor 2B increases bone and muscle mass in a mouse model of osteogenesis imperfecta

Osteogenesis imperfecta（OI） comprises a group of heritable connective tissue disorders generally defined by recurrent fractures, low bone mass, short stature and skeletal fragility. Beyond the skeletal complications of OI,many patients also report intolerance to physical activity, fatigue and muscle weakness. Indeed, recent studies have demonstrated that skeletal muscle is also negatively affected by OI, both directly and indirectly. Given the well-established interdependence of bone and skeletal muscle in both physiology and pathophysiology and the observations of skeletal muscle pathology in patients with OI, we investigated the therapeutic potential of simultaneous anabolic targeting of both bone and skeletal muscle using a soluble activin receptor 2B（ACVR2B） in a mouse model of type Ⅲ OI（oim）. Treatment of 12-week-old oim mice with ACVR2 B for 4 weeks resulted in significant increases in both bone and muscle that were similar to those observed in healthy,wild-type littermates. This proof of concept study provides encouraging evidence for a holistic approach to treating the deleterious consequences of OI in the musculoskeletal system.

Non-alcoholic fatty liver disease connections with fat-free tissues: A focus on bone and skeletal muscle

The estimates of global incidence and prevalence of non-alcoholic fatty liver disease(NAFLD) are worrisome, due to the parallel burden of obesity and its metabolic complications. Indeed, excess adiposity and insulin resistance represent two of the major risk factors for NAFLD; interestingly, in the last years a growing body of evidence tended to support a novel mechanistic perspective, in which the liver is at the center of a complex interplay involving organs and systems, other than adipose tissue and glucose homeostasis. Bone and the skeletal muscle are fat- free tissues which appeared to be independently associated with NAFLD in several cross-sectional studies. The deterioration of bone mineral density and lean body mass, leading to osteoporosis and sarcopenia, respectively, are age-related processes. The prevalence of NAFLD also increases with age. Beyond physiological aging, the three conditions share some common underlying mechanisms, and their elucidations could be of paramount importance to design more effective treatment strategies for the management of NAFLD. In this review, we provide an overview on epidemiological data as well as on potential contributors to the connections of NAFLD with bone and skeletal muscle.

Role of autophagy in bone and muscle biology

Autophagy in eukaryotic cells is a constitutive process and functions as a homeostatic mechanism; it is up-regulated in response to specific stress stimuli such as starvation, hypoxia and as oxidative stress. In addition to playing a crucial role in adaptive responses to different stimuli, autophagy is also required for intracellular quality control. This second aspect is important to prevent the activation of pathological processes. Autophagy also plays a central role in cellular development and differentiation because it is involved in the regulation of energetic balance. This final aspect is critical for maintaining proper bone and muscle function as well as to prevent any pathological changes. Therefore, identifying new molecular targets involved in autophagy is critical to assure a good quality of life.

Assessment of the muscle injury, inflammatory response and bone metabolism after paravertebral muscle space and minimally invasive percutaneous approach surgeries for thoracolumbar fracture

Objective: To study the muscle injury, inflammatory response and bone metabolism after paravertebral muscle space and minimally invasive percutaneous approach surgeries for thoracolumbar fracture. Methods: A total of 92 patients with thoracolumbar fractures who were treated in Baoji Central Hospital between May 2015 and January 2017 were selected and randomly divided into paravertebral group and minimally invasive percutaneous group who accepted pedicle screw fixation under different approaches. Before operation as well as 1 d and 3 d after operation, serum was collected to determine the contents of creatase, inflammatory reaction molecules and bone metabolism indexes. Results: Serum Myo, CK, LDH, TNF-α, MCP-1, HMGB-1, CRP, IL-1β, OC, OPG, PICP and PINP levels of both groups 1 d and 3 d after operation were significantly higher than those before operation while TRACP5b, RANKL, CTX and NTX levels were significantly lower than those before operation, and serum Myo, CK, LDH, TNF-α, MCP-1, HMGB-1, CRP, IL-1β, TRACP5b, RANKL, CTX and NTX levels of paravertebral group 1 d and 3 d after operation were significantly lower than those of minimally invasive percutaneous group while OC, OPG, PICP and PINP levels were significantly higher than those of minimally invasive percutaneous group. Conclusion:Paravertebral muscle space surgery for thoracolumbar fracture is more effective than minimally invasive percutaneous surgery in reducing muscle injury and inflammatory response, and improving bone metabolism.

The Origin of Neointimal Smooth Muscle Cells in Transplant Arteriosclerosis from Recipient Bone-marrow Cells in Rat Aortic Allograft

In order to investigate the origin of neointimal smooth muscle cells in transplant arterio- sclerosis in rat aortic allograft, sex-mismatched bone marrow transplantation was performed from male Wistar rats to female Wistar rats. Four weeks after transplantation, the aortic transplant model was established by means of micro-surgery in rats. The recipients were divided into 4 groups: female Wistar-female Wistar aortic isografts, female SD-female Wistar aortic allografts, male SD-male Wis- tar aortic allografts, female SD-chimera Wistar aortic allografts. Eight weeks after transplantation, aortic grafts were removed at autopsy and processed for histological evaluation and immunohisto- chemistry. The results indicated that excessive accumulation of α-SMA-positive smooth muscle cells resulted in significant neointima formation and vascular lumen stricture in rat aortic allografts. Neointima assay revealed that the neointimal area and NIA/MA ratio of transplanted artery were sig- nificantly increased in all of aortic allograft groups as compared with those in aortic isograft group (P<0.01). Neointimal smooth muscle cells were harvested from cryostat sections of aortic allograft by microdissection method. The Sry gene-specific PCR was performed, and the result showed that a dis- tinct DNA band of 225 bp emerged in the male-male aortic allograft group and chimera aortic al- lograft group respectively, but not in the female-female aortic allograft group. It was suggested that recipient bone-marrow cells, as the origin of neointimal smooth muscle cells, contributed to the pathological neointimal hyperplasia of aortic allograft and transplant arteriosclerosis.

Bone microenvironment regulative hydrogels with ROS scavenging and prolonged oxygen-generating for enhancing bone repair

Large bone defects resulting from fractures and disease are a major clinical challenge,being often unable to heal spontaneously by the body’s repair mechanisms.Lines of evidence have shown that hypoxia-induced overproduction of ROS in bone defect region has a major impact on delaying bone regeneration.However,replenishing excess oxygen in a short time cause high oxygen tension that affect the activity of osteoblast precursor cells.Therefore,reasonably restoring the hypoxic condition of bone microenvironment is essential for facilitating bone repair.Herein,we designed ROS scavenging and responsive prolonged oxygen-generating hydrogels(CPP-L/GelMA)as a“bone microenvironment regulative hydrogel”to reverse the hypoxic microenvironment in bone defects region.CPP-L/GelMA hydrogels comprises an antioxidant enzyme catalase(CAT)and ROS-responsive oxygen-releasing nanoparticles(PFC@PLGA/PPS)co-loaded liposome(CCP-L)and GelMA hydrogels.Under hypoxic condition,CPP-L/GelMA can release CAT for degrading hydrogen peroxide to generate oxygen and be triggered by superfluous ROS to continuously release the oxygen for more than 2 weeks.The prolonged oxygen enriched microenvironment generated by CPP-L/GelMA hydrogel significantly enhanced angiogenesis and osteogenesis while inhibited osteoclastogenesis.Finally,CPP-L/GelMA showed excellent bone regeneration effect in a mice skull defect model through the Nrf2-BMAL1-autophagy pathway.Hence,CPP-L/GelMA,as a bone microenvironment regulative hydrogel for bone tissue respiration,can effectively scavenge ROS and provide prolonged oxygen supply according to the demand in bone defect region,possessing of great clinical therapeutic potential.

Quantitative Evaluation of Fat Composition in Lumbar Vertebral Body and Paraspinal Muscle by Proton Density Fat Fraction with MRI

Purpose: Bone marrow and muscle adiposity have been considered to correlate with osteoporosis and Sarcopenia. Proton Density Fat Fraction (PDFF) can be measured by Magnetic Resonance Imaging (MRI). The purpose of the present study was to measure PDFF in the lumbar spine, paraspinal muscle and subcutaneous fat tissue. Methods: Participants were comprised of 30 patients (18 males, 12 females;age range, 14 - 87 years) who underwent MRI due to low back symptoms. PDFFs for the body of the fourth lumbar vertebra (L4), paraspinal muscle, and subcutaneous fat were measured. Results: PDFFs of the vertebral body and subcutaneous fat were significantly higher than that of paraspinal muscle (p < 0.001). PDFF was significantly higher for subcutaneous fat than for the vertebral body (p < 0.001). Although no significant differences in PDFF of the vertebral body, paraspinal muscle, and subcutaneous fat between females and males, PDFFs of the vertebral body and paraspinal muscle were significantly higher in older subjects (>63 years) than in younger subjects (Conclusions: PDFF of the vertebral body was significantly higher than that of paraspinal muscle. PDFFs of the vertebral body and paraspinal muscle were significantly lower in younger subjects than in older subjects.

Vascular remodeling and mobilization of bone marrow-derived cells in cuff-induced vascular injury in LDL receptor knockout mice

Background Vascular remodeling is an important pathologic process in vascular injury for various vascular disorders such as atherosclerosis, postangioplasty restenosis and transplant arteriopathy. Recently, pathologic change and the role of bone marrow derived cells were wildly studied in atherosclerosis and restenosis. But the manner of lesion formation in neointima and cell recruitment in vascular remodeling lesion in the present of hypercholesterolemia is not yet fully understood. Methods Double-transgenic mice knockout of LDL receptor gene （LDL-/-） and expressing ubiquitously green fluorescent protein （GFP） were obtained by cross-breeding LDL -/- mice with the GFP-expressing transgenic mice. LDL-/- mice （22-24 weeks of age） fed high fat diet containing 1.25% （w/w） cholesterol were subjected to 9Gy irradiation and received bone marrow （BM） cells from the double-transgenic mice. Four weeks later, a nonconstrictive cuff was placed around the right femoral artery. After another 2 weeks, both right and left femoral arteries were harvested and subjected to histochemical analysis. Apoptosis was analyzed in situ using TUNEL assay. Results Two weeks after cuff placement, atherosclerotic lesions developed in the intima consisting of a massive accumulation of foam cells. The tissue stained with anti-α smooth muscle actin （SMA） antibody, showed a number of SMA-positive cells in the intimal lesion area. They were also positive for GFP, indicating that BM-derived cells can differentiate to SMCs in the intima in cuff-induced vascular remodeling lesions. Numerous small vessels in the adventitia as well as the endothelial lining of the intima were positive both for CD31 and GFP. The intima and media showed a large number of TUNEL-positive signals after 2 weeks cuff injury, indicating the presence of apoptosis in vascular remodeling. Conclusions Atherosclerotic lesions in mice can be developed in the intima after 2 weeks of cuff-induced vascular injury under the hypercholesterolemic conditions. Our data also clearly indicate that bone marrow-derived cells differentiated to smooth muscles and endothelial cells in the formation of these lesions in the presence of hypercholesterolemia.

All-trans retinoic acid promotes smooth muscle cell differentiation of rabbit bone marrow-derived mesenchymal stem cells

Bone marrow-derived mesenchymal stem cells are multipotent stem cells, an attractive resource for regenerative medicine. Accumulating evidence suggests that all-trans retinoic acid plays a key role in the devel- opment and differentiation of smooth muscle cells. In the present study, we demonstrate, for the first time, that rabbit bone marrow-derived mesenchymal stem cells differentiate into smooth muscle cells upon the treatment with all-trans retinoic acid. AII-trans retinoic acid increased the expression of myocardin, caldesmon, 22-kDa smooth muscle cell- specific protein （SM22Q）, and SM-myosin heavy chains in rabbit bone marrow-derived mesenchymal stem cells, as detected by reverse transcription polymerase chain reaction （PCR）. Immunostaining of SM22a and SM-myosin heavy chains using monoclonal antibodies also indicated smooth muscle cell differentiation of rabbit bone marrow- derived mesenchymal stem cells following the treatment with all-trans retinoic acid. In addition, more than 47% of bone marrow-derived mesenchymal stem cells demonstrated the contractile phenotype of smooth muscle cells. Western blot results showed that SM-1 and SM-2 were highly expressed in the differentiated cells. These results suggest that all-trans retinoic acid may serve as a potent agent for functional smooth muscle cell differentiation in tissue engineering.

Type ⅡB human skeletal muscle fibers positively correlate with bone mineral density irrespective to age

Background Age-associated decrease in type ⅡA/B human skeletal muscle fibers was detected in human biopsies in our previous study. The relationship between change in muscle fiber typing and bone mineral density （BMD） is, however,unknown either cross-sectionally or longitudinally. We therefore conducted a cross-sectional study to investigate their correlation using human muscle biopsies.Methods Forty human subjects aged （53.4±20.2） years were recruited. Histomorphometric parameters of their muscle biopsies were measured by ATPase staining and image analysis, including average area percentage, fiber number percentage, mean fiber area, and area percentage of connective tissues. Hip and spine BMD was measured by dual-energy X-ray absorptiometry. Partial correlation with adjusting age was performed.Results Type ⅡB muscle fiber was found positively correlated with hip BMD irrespective to age and demonstrated significantly stronger relationship with BMD among all fiber types, in terms of its cross-sectional area （r=0.380, P=0.029）and size （r=0.389, P=0.025）. Type ⅡA muscle fibers associated with hip BMD in mean fiber area only （r=0.420, P=0.015）.Conclusions Type ⅡB muscle fiber may play an important role in maintaining bone quality. This may also be a relatively more sensitive fiber type of sarcopenia and osteoporosis. These findings further consolidate the muscle-bone relationship.

Relationship between Muscle Strength, Muscle Mass and BMD in Postmenopausal Female of Zhuang in Guangxi Province of China

Objective: To explore the correlation between muscle strength, muscle mass and bone mineral density (BMD) in Zhuang female population, body composition analysis and grip strength, and to analyze the possible influencing factors of BMD. Methods: 182 postmenopausal women were selected from Guangxi Province of China. Broadband ultrasound attenuation (BUA) was used to evaluate BMD. Grip dynamometer to assess muscle strength. Height, weight and muscle mass of each part were measured by body composition measuring instrument. Body mass index (BMI), skeletal muscle mass index (SMI) and limb skeletal muscle mass (SM) were calculated according to the measurement results. Results: BUA, grip strength and SMI in postmenopausal women of Zhuang nationality showed a decreasing trend with age (p p p r = 0.305, p Conclusion: With the increase of age, the decline rate of muscle strength of postmenopausal Zhuang women in Guangxi is slower than that of BMD and muscle mass. SM can better reflect the BMD level of the body than SMI, and the LSM is the main influencing factor of BMD.

A Novel Apprehension of the Primary Lung Meridian, Sinew Channel, Divergent Channel, Luo-Connecting Channel Acting as a Single Unit System to Serve Respiration Function Based on Modern Neurophysiology and Kinesiology

The TCM philosophy of a meridian and associated channels pertains to the specific function of one or more organs. We define the Lung Primary Meridian (LUM) together with the Lung Sinew (LUSC), Divergent (LUDC), Luo-connecting (LULCC) Channels as a system of routes plus some parts of the body (such as muscles) to fulfil respiration, as a main function under different situations. There is very limited information about the Lung associated channels in classical literature of TCM. With a clear focus on the function of respiration, we have carried out a detailed analysis of the biomedical consequence of stimulating the LUM, analysed the roles played by LUSC, LUDC, and LULCC. The updated LUM and LUDC include acupoints of other meridians, serving the same purpose of performing satisfactory respiration starting from checking the quality of the inflow through the nose. The LUSC includes the respiratory muscles (plus the associated connective tissues) extending to various parts of the body. The muscles of the limb (as part of the LUSC) embrace the nerves that provide routes for somatosensory reflexes and play the role of locomotion, providing voluntary respiration via the pectoralis muscles. The muscles of LUSC are bounded by stiff connective tissue layers, forming compartments, and are part of the pulley system for various body locomotions. Within a compartment, the interstitial fluid, blood, lymph flows must be potent to protect the associated nerves related to LUM;the healthy state of the LUSC also provides freedom of various types of locomotion. The LULCC exists because the vagus nerve has a part of it passing through the spinal cords all the way down to the sacrum domain, with exiting nerve innervating two-third of the large intestine. The crucial steps of our deductions are supported by experimental evidence based on modern neurophysiology and kinesiology. We discover that all the four channels stated above work as a unit system to allow respiration to be possible under various postures/conditions. The complexity of structures and processes is eased off by providing 29 figures and 13 tables for the relevant muscles and nerves. In addition to respiration, the Lung system in TCM context includes interaction of this system with the sweat gland and neuroendocrine system;such aspects will be left to another study.

基于“筋骨平衡”理论针刺推拿疗法治疗椎动脉型颈椎病的临床观察

目的浅析椎动脉型颈椎病(cervical spondylotic vertebral arteriopathy,CSA)患者实施基于“筋骨平衡”理论针刺推拿疗法对其中医症状积分、颈性眩晕症状与功能评估量表(cervical vertigo symptom and function assessment scale,ESCV)评分、颈椎曲度及脑血流参数的影响。方法选择该院2019年12月—2021年12月就诊的CSA患者86例实施研究,随机数字表法分作观察组与对照组,各43例;其中对照组脱落2例,剔除1例,共完成40例;观察组脱落1例,剔除1例,共完成41例;对照组予以常规牵引疗法,观察组予以基于“筋骨平衡”理论针刺推拿疗法;比较两组治疗前与治疗后中医症状积分、ESCV评分、颈椎曲度及脑血流参数的变化,并对比两组疗效。结果治疗后,观察组中医症状积分皆显著低于对照组(P<0.05)。治疗后,观察组ESCV评分和颈椎曲度皆明显高于对照组(P<0.05)。治疗后,观察组椎底动脉及左、右椎动脉的Vs与Vd水平均显著高于对照组(P<0.05)。观察组总有效率显著高于对照组[95.12%(39/41)vs 80.00%(32/40),P<0.05]。结论基于“筋骨平衡”理论针刺推拿疗法对CSA患者疗效显著,有效改善中医症状积分、ESCV评分以及颈椎曲度,增强脑血流参数。

理筋正骨手法与Maitland关节松动技术治疗神经根型颈椎病的疗效对比

目的探讨理筋正骨手法与Maitland关节松动技术治疗神经根型颈椎病的疗效差异.方法选取2022年1—8月杨浦区中医医院收治的神经根型颈椎病患者62例,随机将其分为理筋正骨组(n=31)和关节松动组(n=31).两组患者均进行颈椎牵引,理筋正骨组在颈椎牵引的基础上给予理筋正骨手法治疗,关节松动组在颈椎牵引的基础上给予Maitland关节松动技术治疗.两组干预时间均为2周.比较两组田中靖久评分和疼痛视觉模拟(VAS)评分.结果治疗前,两组患者的田中靖久评分和VAS评分相比,组间差异无统计学意义(P>0.05);治疗2周后,理筋正骨组的田中靖久评分(14.50±1.46)分高于关节松动组的(13.67±1.63)分,VAS评分(1.73±0.64)分低于关节松动组的(2.03±0.49)分,组间差异有统计学意义(P<0.05).结论理筋正骨手法与Maitland关节松动技术均可有效改善神经根型颈椎病患者的临床症状,而理筋正骨手法可做到"筋骨并重",疗效优于Maitland关节松动技术.

艾灸对去卵巢大鼠肌肉功能及骨密度的研究

目的观察艾灸“肝俞”“肾俞”对去卵巢大鼠腰部肌群杨氏模量值、后肢步态参数和骨密度的影响,基于“筋骨互用”理论探讨艾灸在改善去卵巢大鼠肌肉功能中的作用。方法将32只SD大鼠随机分为4组:假手术组、模型组、艾灸组、雌激素组,每组8只。模型组、艾灸组和雌激素组均去势,艾灸组穴取双侧“肝俞”“肾俞”,每次15 min,隔日1次,每周3次,共12周。干预结束后采用实时剪切波超声弹性成像技术(SWE)测定大鼠腰部肌群杨氏模量值;步态分析系统WalkAnalysator VTX记录后肢支撑时长(s)、摆动时长(s)、摆动速度(cm/s)和步宽(cm);Miro-CT检测右侧股骨骨密度(BMD)、骨体积分数(BV/TV)、骨小梁厚度(Tb.Th)和骨小梁分离度(Tb.Sp)。结果与假手术组比较,模型组大鼠腰部肌群杨氏模量值下降(P<0.01),后肢支撑时长、摆动时长、步宽增大(P<0.05,P<0.01),摆动速度减小(P<0.01),右侧股骨BMD、Tb.Th、BV/TV降低(P<0.01),Tb.Sp增大(P<0.01)。与模型组比较,艾灸组和雌激素组大鼠腰部肌群杨氏模量值上升(P<0.05),后肢支撑时长、摆动时长、步宽缩短(P<0.05,P<0.01),摆动速度增大(P<0.01),右侧股骨BMD、Tb.Th、BV/TV增加(P<0.01),Tb.Sp减小(P<0.01)。结论艾灸“肝俞”“肾俞”可提升去卵巢大鼠的腰部肌群杨氏模量值,影响后肢步态参数,从而改善肌肉功能以提高骨密度,从“筋骨互用”的角度为防治骨质疏松症提供中医方案。

腰椎手法配合电针治疗急性非特异性下腰痛临床观察

目的评价基于“筋骨并举”思想指导的腰椎手法配合电针治疗急性非特异性下腰痛的疗效。方法68例患者随机分为两组各34例。观察组采用腰椎手法配合电针治疗,对照组单纯采用电针治疗。治疗前和治疗2周后评价疼痛视觉模拟量表(VAS)评分、日本骨科协会评分量表(JOABPEQ)、Oswestry功能障碍指数(ODI)评分、指地距离(FFD)、Schober试验距离。结果治疗后,两组患者VAS、JOABPEQ、ODI的评分及FFD、Schober试验距离均较治疗前改善(P<0.05),且观察组各项评分更优(P<0.05)。结论基于“筋骨并举”思想指导的腰椎手法配合电针治疗能更加有效地治疗急性非特异性下腰痛,值得推广。

双能量CT联合肌骨超声鉴别诊断焦磷酸钙沉积病与痛风性关节炎的价值

目的 探究双能量CT联合肌骨超声鉴别诊断焦磷酸钙沉积病与痛风性关节炎的价值。方法 回顾性分析痛风性关节炎102例和焦磷酸钙沉积病102例患者的病历资料,分别记为痛风组和钙沉积组。所有患者均行双能量CT和肌骨超声检查,并以关节滑液或关节腔内晶体物质的穿刺结果作为金标准。评估双能量CT、肌骨超声诊断焦磷酸钙沉积病与痛风性关节炎的效能。结果 痛风组患者的男性比例、血尿酸均高于钙沉积组(P <0.05)。痛风组患者中膝关节、第一跖趾关节、踝关节的受累率偏高,钙沉积组患者中膝关节、腕关节、肩关节的受累率偏高。痛风组患者的骨皮质不规则、软骨损伤、半月板退行性变的所占比例均低于钙沉积组(P <0.05)。痛风组患者的双轨征、痛风石、韧带内强回声、肌腱内强回声、骨侵蚀占比高于钙沉积组(P <0.05),软骨钙化低于钙沉积组(P <0.05)。双能量CT、肌骨超声及二者联合诊断焦磷酸钙沉积病和痛风性关节炎的灵敏度分别为86.27%、83.33%、94.12%,特异度分别为89.22%、88.24%、86.27%,阳性预测值分别为88.89%、87.63%、87.27%,阴性预测值分别为86.67%、84.11%、93.63%,准确率分别为87.75%、85.78%、90.20%,一致性Kappa值分别为0.755、0.716、0.804。结论 双能量CT联合肌骨超声在焦磷酸钙沉积病与痛风性关节炎中的诊断效能良好,可用于辅助鉴别诊断两种疾病。