Ultrasound-guided injection of platelet-rich plasma alleviated pain and improved function for individuals with myofascial pain syndrome: a retrospective case series study

Abstract

Background

Myofascial pain syndrome (MPS) is a regional musculoskeletal pain associated with myofascial trigger point (MTrP), lacks therapies with sustained efficacy. Current modalities offer short-term relief but fail to address underlying tissue degeneration.

Objectives

This study aimed to evaluate the 3-month safety and efficacy of ultrasound-guided platelet-rich plasma (PRP) injections in alleviating MPS-related pain and function.

Methods

From January 2023 to April 2023, we selected 71 eligible individuals with MPS who received PRP treatment of the upper trapezius, rhomboid, erector spinae, and quadratus lumborum in the Department of Rehabilitation Medicine, West China Hospital, Sichuan University, a retrospective case series study. Primary outcome was pain quantified by the Visual Analog Scale (VAS) and the McGill Pain Questionnaire (McGill). Secondary outcomes were region-specific functional improvement evaluated using the Neck Disability Index (NDI) for cervical pathology and the Oswestry Disability Index (ODI) for lumbar conditions, with additional assessment via the Roland Morris Disability Questionnaire (RMDQ), and quality of life measured by the Medical Outcomes Short Form-36 (SF-36). These parameters were evaluated at baseline and 24 h, 2 weeks, 1 month, and 3 months post-treatment.

Results

The cohort included 71 individuals (mean age 47.6 ± 15.9 years; 71.8% female) with chronic MPS. The pain VAS decreased from 5.0 [4.0–6.0] at baseline to 1.0 [1.0–2.0] at 3 months (p < 0.001), with the McGill decreased from 11.0 [8.0–15.0] to 2.0 [2.0–5.0] (p < 0.001). The NDI decreased from 42.0 [29.3–53.3] at baseline to 9.5 [5.0–11.0] (p < 0.001). The ODI declined from 22.0 [14.0–29.0] to 10.0 [6.0–14.0] (p < 0.001). The RMDQ showed improvement, from 10.0 [6.5–16.0] to 4.0 [2.0–5.0] (p < 0.001). Similarly, the SF-36 score was obviously improved 3 months post-treatment of PRP (p < 0.01). No adverse reactions were reported during follow-up.

Conclusion

Ultrasound-guided platelet-rich plasma treatment could significantly alleviate the pain and improve the physical function and quality of life in the individuals with myofascial pain syndrome during 3-months follow-up.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-025-08884-6.

Introduction

Myofascial pain syndrome (MPS) is a common condition of musculoskeletal pain [1], characterized by the presence of myofascial trigger points (MTrP) [2, 3]. MTrP is a palpable hard nodule located within skeletal muscles or fascia that cause pain when compressed, as well as related to chronic, regional musculoskeletal diseases. The prevalence of MPS is high [4], accounting for approximately 30–85% of musculoskeletal individuals [5]. The main reason for the formation of MTrP is injury to muscle tissue caused by trauma, abnormal posture, sports injury and dysfunction of the motor endplate [6, 7]. The motor endplate releases excessive acetylcholine [8], resulting in the continuous contraction of skeletal muscle fibers and the formation of contraction nodules. Persistent muscle contraction leads to local ischemia, hypoxia, and high metabolism, further stimulating the release of a large number of pain-causing substances in local tissues, forming a vicious cycle [9]. MPS has a significant impact on the quality of daily life and work of individuals, prolonged pain can also cause mental health problems such as attention disorders, anxiety and depression [10].

Intervention modalities utilized for the management of MPS encompass manual therapy, physical therapy, pharmacotherapy, acupuncture, injection, and traditional Chinese medicine [11]. Among these modalities, manual therapy and physical therapy can alleviate pain, but it is prone to episodic manifestation and recurrent attacks of pain. Therapeutic exercise can stretch skeletal muscles and improve physical function, but early intervention of exercise in the acute phase of inflammation could further exacerbate pain, spasms, and tension in the affected skeletal muscles [12]. Acupuncture or dry needling provides better outcomes than manual therapy toward inactivating MTrP, but the duration of action is limited and also cause damage to skeletal muscles and myofascial [13]. Ferrante et al. conducted a randomized, controlled, and double-blind study indicating that injection of MTrP with botulinum toxin A did not alleviate MPS pain and had a significant placebo effect [14]. Research has shown that the main problems with the above treatment methods are inaccurate localization of MTrP and incomplete inactivation processes [15, 16] or recurrent MPS pain caused by various confounding factors [17, 18]. While dry needling and botulinum toxin provide short-term relief, PRP, enriched with growth factors, offers regenerative potential but lacks long-term efficacy data [19]. The bands, indurations, and fibrosis of muscle fibers around MTrP cause adhesions, contractures, and scar formation within the myofascial system [20]. It is speculated that the outcome of MPS treatment depends on the inactivation of MTrP and the restoration of the surrounding myofascial system [21].

Platelet-rich plasma (PRP) is a platelet concentrate obtained from whole blood after centrifugation that regulates inflammation and immunity and promotes tissue regeneration [22]. Agarwal et al. proved that using PRP solution injection has a better effect than dry acupuncture on pain and patient’s satisfaction with regard to the treatment of MPS individuals of masseter by performing a randomized scientific control study [23]. Meanwhile, in the clinical diagnosis and treatment process, we found that ultrasound-guided precise targeted injection is significantly effective for refractory localized myofascial pain syndrome [24]. In addressing gaps identified in prior studies, such as inconsistent ultrasound guidance, limited follow-up duration, and reliance on subjective outcome, our study aims to integrate a standardized ultrasound-guided PRP therapy with long-term follow-up, multidimensional assessment scales. Hence, this study aimed to confirm the effect of ultrasound-guided PRP injection for alleviating pain and symptoms of MPS individuals.

Materials and methods

This is a retrospective case series study. We selected 71 MPS individuals who met the inclusion criteria and received PRP injection treatment at the Rehabilitation Medical Center of West China Hospital, Sichuan University from January to April 2023. The study was conducted following the Declaration of Helsinki and the International Coordinating Conference: Guidelines for Good Clinical Practice. All individuals signed an informed consent form to participate in the study and received sufficient verbal and written information describing the experiment. This study was approved by the Biomedical Research Ethics Committee of West China Hospital of Sichuan University No. 2023 (633) and Clinical Trial (Registration No. ChiCTR2300074199) was registered on 2023.8.1.

Inclusion/Exclusion criteria

In this study, we searched the Hospital Information System (HIS) at the Rehabilitation Medical Center of West China Hospital, Sichuan University, and identified 71 individuals diagnosed with MPS (ICD-10: M79.1) confirmed by board-certified physician, who had received ultrasound-guided PRP injection therapy. Each of them had comprehensive and detailed medical records available, and had not received any other treatment. Inclusion criteria comprised adults aged 20–70 years meeting diagnostic criteria for MPS as follows: regional pain with sensory abnormalities in expected referred pain distributions, palpable taut bands within affected muscles, severe localized tenderness at trigger points within taut bands, restricted range of motion, and at least one secondary feature (e.g., reproducible pain upon palpation or induction of a local twitch response). Comorbidities (e.g., diabetes, hypertension) were documented but did not exclude participation unless affecting treatment safety (e.g., uncontrolled diabetes). Exclusion criteria included coagulopathy, systemic inflammatory conditions, or prior treatment with botulinum toxin. This protocol aligns with established MPS diagnostic frameworks emphasizing taut band identification, tenderness, and functional impairment [3].

Intervention

Preparation of PRP

Approximately 40 mL of venous blood was collected from the elbow vein with a special large-diameter needle, the blood was mixed with anticoagulant (sodium citrate) (5 times to prevent microbubbles), and the solution was distributed into an anticoagulant vacuum tube. PRP was prepared using WEGO (II-40 ml) using a blood cell separation and single collection protocol using two double spin centrifugation processes [25]. The temperature during the centrifugation process was room temperature (21 °C). Approximately 6 mL of PRP was obtained. A certain amount of white blood cells is mixed in the generated PRP. Before centrifugation, there was no blood cooling, and the prepared PRP was immediately injected.

Process of injection

Both diagnosis and treatment were made by two physicians with > 10 years of musculoskeletal pain management experience. The therapeutic procedure was conducted as follows: After initial localization of MTrPs via manual palpation, standardized objective assessments—including surface electromyography (sEMG), Myoton muscle elasticity testing, and infrared thermography—were performed to quantify baseline neuromuscular and biomechanical parameters. Anatomical reference points were strictly defined: for cervical regions, MTrPs were standardized at 5 cm lateral to the spinous process of the 7th cervical vertebra (C7) within the trapezius muscle; for lumbar regions, sites were fixed at 2 cm lateral to the 3rd lumbar vertebra (L3) spinous process within the erector spinae muscle. Under sterile conditions, ultrasound-guided PRP injection was performed using a 22G needle advanced to the vicinity of the identified MTrPs. Ultrasound-guided PRP injections were performed using a longitudinal scan with an in-plane needle approach. A total of 2 mL PRP was administered per site, targeting the perimysium, epimysium, and extramuscular fascial layers surrounding the MTrPs (Fig. 1).

Fig. 1.

Schematic of the treatment procedure of ultrasound-guided PRP injection. A: Schematic of PRP preparation, the upper right is leukocyte-poor PRP, and the lower right is leukocyte-rich PRP. B: Ultrasound-guided injection of PRP of the UT; Ultrasound images during injection of UT. C: Ultrasound-guided injection of PRP of the quadratus lumborum (QL); Ultrasound images during injection of QL. Arrows point to the needle. R: Right; L: Left; UT: upper trapezius muscle; ES: Erector Spinae; QL: Quadratus Lumborum; K: kidney; Abd: abdomen

Evaluation index

The efficacy of PRP therapy was evaluated through a hierarchical framework of outcomes. Primary Outcome: Pain was assessed using the Visual Analog Scale (VAS), a validated and widely utilized tool with high test-retest reliability (ICC > 0.85) and strong construct validity in acute and chronic pain populations [26]. The McGill Pain Questionnaire (McGill), a multidimensional instrument demonstrating robust internal consistency (Cronbach’s α > 0.80) and criterion validity against quantitative sensory testing [27], quantified sensory and affective dimensions of pain. Secondary Outcomes were function and quality of life. Function assessed by the Neck Disability Index (NDI), which exhibits excellent reliability (ICC = 0.88–0.93) and responsiveness in cervical disorders [28], the Oswestry Disability Index (ODI) and Roland Morris Disability Questionnaire (RMDQ) [29]. Quality of Life was evaluated by the Short Form-36 (SF-36), a psychometrically robust measure with established internal consistency (α > 0.70 across domains) and convergent validity in musculoskeletal populations [30], evaluated physical, emotional, and social well-being. We also used minimal clinically important differences (MCID) to evaluate the value of improvements in pain, function, and quality of life in the study. It was defined as a baseline change, based on clinician consensus and in line with musculoskeletal rehabilitation [31]. Baseline measurements were established pre-treatment. Follow-up assessments occurred at 24 h, 2 weeks, 1 month, and 3 months post-intervention. Notably, the SF-36, designed to reflect comprehensive health perceptions over the preceding month, was administered only at the 1 and 3-month follow-ups to align with its retrospective time frame and optimize validity. Clinical procedures and assessments were standardized, with a single physician performing interventions and a separate therapist collecting data to ensure measurement consistency and minimize variability.

Statistical analysis

Data normality was assessed using the Shapiro-Wilk test. Normally distributed data were reported as the mean with 95% confidence interval (CI) and analyzed using one-way analysis of variance (ANOVA) followed by Tukey’s post-hoc tests. Non-normally distributed data presented as the median with interquartile range M (Q1, Q3) and analyzed using the Friedman’s rank test (α = 0.05), with Bonferroni correction for multiple post-hoc comparisons. Statistical analysis was performed using SPSS Statistics V29.0 (IBM^®, US).

Results

The characteristics of 71 cases are presented in Table 1. The average age of the 71 individuals in this study was 47.6 ± 15.9 years old, of which 51 were female, accounting for 71.8%. Upon testing, the data for VAS, McGill, RMDQ, ODI, NDI, and SF − 36 in our study were found to be non - normally distributed. Therefore, we presented these data as the median M (Q1, Q3) and analyzed them using the Friedman’s rank test (α = 0.05), with Bonferroni correction for post - hoc comparisons.

Table 1.

Demographic and clinical characteristics of the study population

Characteristics	Value
Total cases, n	71
Age (years), mean ± SD	47.6 ± 15.9
Female, n (%)	51 (71.8)
Affected region, n (%)
Cervical MPS	22 (31.0)
Lumbar MPS	49 (69.0)

PRP treatment alleviated the pain of individuals with MPS

The primary symptoms of MPS are muscle pain and musculotendinous pain. After PRP treatment, pain was significantly reduced in 24 h, with the VAS score decreasing from 5.0(4.0, 6.0) to 3.0(3.0, 4.0). After 2 weeks, the average pain level continued to significantly decrease, with a VAS score of 2.0(2.0, 3.0). However, after 1 month, the average pain level only slightly decreased, with a VAS score of 2.0(1.0, 3.0). Following treatment, VAS pain scores decreased significantly in the PRP treatment group (=202.38; p < 0.001). The overall decrease during follow-up in VAS pain scores was significant over time, at 24 h, 2 weeks, 1 month, and 3 months post-treatment (p < 0.05). Similarly, McGill score also decreased significantly during the follow-up (=205.11; p < 0.001). As more follow-up were provided, the McGill scores decreased significantly (p < 0.05), indicating pain relief at 24 h, 2 weeks, 1 month, and 3 months after treatment. The results are presented in Table 2. In our study, the individuals who underwent PRP injection showed great improvement in pain relief, PRP had a mid-term efficacy in relieving pain ( ≥ 3 months).

Table 2.

Ultrasound-guided PRP treatment improved the pain and physical function of individuals with MPS

	Baseline	24 h	2 weeks	1 month	3 months		p 1
VAS	5.0(4.0, 6.0)	3.0(3.0, 4.0) *	2.0(2.0, 3.0) *†	2.0(1.0, 3.0) *†	1.0(1.0, 2.0) *†	202.38	< 0.01
McGill	11.0(8.0, 15.0)	8.0(6.0, 10.0) *	4.0(2.0, 7.0) *†	4.0(2.0, 5.3) *†	2.0(2.0, 5.0) *†	205.11	< 0.01
NDI	42.0(29.3, 53.3)	32.5(23.3, 40.5)	28.0(18.8, 33.8)	10.0(7.5, 13.0) *†‡	9.5(5.0, 11.0) *†‡	69.63	< 0.01
RMDQ	10.0(6.5, 16.0)	7.0(4.0, 12.0) *	5.0(3.0, 7.5) *	4.0(3.0, 6.5) *	4.0(2.0, 5.0) *	133.40	< 0.01
ODI	22.0(14.0, 29.0)	17.0(12.0, 24.0)	10.0(6.0, 16.0) *†	10.0(5.5, 14.0) *†	10.0(6.0, 14.0) *†	85.79	< 0.01

¹ Related-Samples Friedman’s Two-Way Analysis of Variance by Ranks; * Statistically significant difference compared to the baseline, p < 0.05; ^†Statistically significant difference compared to 24 h, p < 0.05; ^‡Statistically significant difference compared to 2 weeks, p < 0.05; VAS: visual analog scale; McGill: McGill Pain Questionnaire; NDI: Neck Disability Index; RMDQ: Roland Morris Disability Questionnaire; ODI: Oswestry Disability Index

PRP treatment improved the physical function of individuals with MPS

In MPS individuals, chronic pain can lead to the decline of physical function. We studied the changes of physical function of low-back and neck after PPR treatment. RMDQ indicates a significant difference in the scores before treatment compared to previous follow-up (=133.40; p < 0.001). In the multiple comparison analysis, the data revealed that compared to the RMDQ baseline score scores observed at 24 h, 2 weeks, and 1-month post-treatment was significantly decreased (p < 0.05). In a similar vein, The ODI demonstrated a significant decrease in scores pre-treatment versus subsequent follow-up (=85.79; p < 0.001). Further, in the multiple comparison, it was noted that the baseline ODI index was significantly greater than the scores recorded at 2 weeks, 1 month, and 3 months after treatment (p < 0.05). The NDI also showed a significant disparity in scores pre-treatment compared to earlier follow-ups (=69.63; p < 0.001). Additionally, the NDI score also decreased significantly in the follow-up (p < 0.05) The results are presented in Table 2 and Appendix 1.

PRP treatment improved the quality of life in individuals with MPS

Persistent chronic pain and dysfunctions affects the quality of life of the individuals. This study also examined the changes in quality of life after treatment. In each item of the SF-36 scoring scale, the verified data don’t obey a normal distribution, and we used the Friedman’s Two-Way Analysis of Variance by Ranks. The results show that all of them, including physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE) and mental health (MH) show significant differences(p <0.01). The results are presented in Table 3 and Appendix 2. The preliminary results indicate that PRP injections treatment could reduce pain and improve motor function and, therefore, the quality of life of the individuals whit MPS in trapezius, quadratus lumborum and erector spinalis during 3 months.

Table 3.

PRP treatment improved the quality of life in individuals with MPS using SF-36 questionnaire.

	Baseline	1 month	3 months		p 1
PF	65.0(50.0, 85.0)	85.0(75.0, 95.0) *	90.0(85.0, 100.0) *	91.10	< 0.01
RP	50.0(0.0, 75.0)	75.0(75.0, 100.0) *	100.0(75.0, 100.0) *	78.46	< 0.01
BP	64.0(52.0, 74.0)	84.0(74.0, 84.0) *	84.0(84.0, 100.0) *†	107.09	< 0.01
GH	60.0(40.0, 75.0)	65.0(55.0, 75.0) *	70.0(55.0, 75.0) *	30.06	< 0.01
VT	75.0(65.0, 80.0)	75.0(70.0, 80.0) *	75.0(70.0, 80.0) *	30.23	< 0.01
SF	87.5(75.0, 100.0)	100.0(87.5, 112.5) *	100.0(87.5, 112.5) *	57.57	< 0.01
RE	66.7(33.3, 100.0)	100.0(66.7, 100.0) *	100.0(66.7, 100.0) *	68.10	< 0.01
MH	72.0(68.0, 84.0)	76.0(68.0, 84.0)	92.0(76.0, 92.0) *†	71.25	< 0.01

¹ Related-Samples Friedman’s Two-Way Analysis of Variance by Ranks; ^* Statistically significant difference compared to the baseline, p < 0.05; ^† Statistically significant difference compared to 1 month, p < 0.05; PF: Physical Functioning; RP: Role-physical; BP: Bodily Pain; GH: General Health; VT: Vitality; SF: Social functioning; RE: Role-emotional; MH: Mental health

Our study determined MCID using an anchor-based approach with median difference methods for non-normally distributed data. In this study, the MCID values were: 4 for VAS pain improvement, 9 for McGill, 32.5 for NDI neck function, 12 for ODI lumbar function improvement, and 6 for RMDQ. Previous literature shows that for spinal, neck or low-back pain and dysfunction research, MCID values are: 2.1 for VAS, 1 for McGill, 3.5 for NDI, 5 for ODI, and 2.5 for RMDQ [32, 33]. In our study, 95.8% of participants benefited from SF-36 in terms of quality of life. Literature search found few studies on post - minimally invasive shoulder and lumbar treatment life satisfaction. Previous reports put the SF-36 benefit rate at least 76.8% [34], indicating our study achieved better results.

This study or follow-up found no treatment-related adverse events. The intervention methods used in our study were relatively safe. In previous studies, this technique may cause mild adverse reactions, such as local injection reactions, redness and swelling at the puncture site, local pain, and subcutaneous bleeding, which can be fully controlled through appropriate treatment, including immediate ice application for transient discomfort and post-procedure activity modification.

Discussion

This study retrospectively investigated the safety and efficacy of ultrasound-guided PRP treatment in the individuals with MPS. The results showed that the ultrasound-guided PRP could be accurately injected into the myofascial trigger point-induced pain region of the affected muscle, leading to the reduced pain and improved function in the individuals with MPS. During the follow-up period, no adverse effect has been reported. The present study has demonstrated that the PRP treatment could be a safe and effective regimen for MPS.

The activated MTrP manifests as spontaneous and involvement pain and produces local twitchreactions when stimulated, while the latent MTrP causes pain only when forcefully pressing or needling [35]. Travel and Simons proposed the “energy crisis theory” of MTrP, stating that dysfunctional motor endplates lead to a sustained contraction of skeletal muscle fibers and the formation of MTrP, leading to local ischemia, hypoxia, and high-energy metabolism [36]. The current treatment methods cannot provide the visualization of MTrP; thus, it is difficult to evaluate if the MTrP could be accurately inactivated. In the present study, ultrasound was used to accurately visualize the strike of MTrP when the needle touches the MTrP. Ultrasound guidance ensures precise MTrP targeting, potentially enhancing outcomes. During the 3-month follow-up, the pain intensity was reported to be gradually decreased, proving that the effect of PRP could be maintained for a long time.

The similar results have been reported in the previous studies. Agarwal and Moraissi et al. posited that PRP injection for the individuals with masticatory muscle MPS is more effective in pain reduction than dry needling [23, 37]. Nitecka-Buchta and colleagues demonstrated that PRP outperforms isotonic saline injection in both pain alleviation and sustained therapeutic efficacy for temporomandibular disorder individuals [38]. Sakalys et al. found that PRP injections, when compared to lidocaine injections, provide superior relief from myofascial pain in masticatory muscles [39]. Yilmaz and team indicated that PRP is as effective as botulinum toxin for treating MTrP in the masseter muscle [19]. The aberrant motor endplate proximal to the MTrP excessively releases acetylcholine, precipitating the sustained contraction of skeletal muscle fibers and engendering contractile nodules. This persistent muscle contraction results in ischemia, hypoxia, and hypermetabolism, further prompting local tissues to release an abundance of pain-inducing substances, including 5-HT, histamine, substance P, interleukins, bradykinin, and tumor necrosis factor [40], and stimulates nerve endings to produce pain, also induce abnormal release of acetylcholine, forming a vicious cycle. The cytokines released from platelet lysis of PRP could inhibit the release of inflammatory substances [41], which might be the reason that PRP has the potential of breaking this vicious cycle locally. These evidence show that PRP treatment could alleviate inflammation and pain in MPS.

During the 3-month follow-up period, significant improvements in NDI, ODI and RMDQ scores suggested sustained functional restoration in cervical and lumbar regions following PRP therapy. Mechanistically, growth factors derived from PRP, including platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF), exert anti-inflammatory effects through suppression of key pro-inflammatory mediators: C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) [42, 43], while promoting muscle fiber regeneration and myofascial repair [44], which in turn aids in the restoration of muscle fiber functionality [45]. Therefore, it is anticipated that the therapeutic effectiveness of PRP treatment will be maintained over a prolonged period, thereby augmenting functional mobility in the lower back and neck areas.

PRP injection could significantly improve quality of daily life in the individuals with MPS, including physical function, role physical, body pain, general health, vitality, social function, role emotional and mental health. Ko and Mindra et al. showed that PRP has shown clinical utility in reducing chronic pain, improving quality of life and improving function for sacroiliac joint dysfunction [46]. There are relatively few studies on improving the quality of daily life in the efficacy of PRP in the treatment of MPS, which may be due to the lack of long-term follow-up or research methodology. Our study showed that PRP treatment improved the quality of life, and provided evidence-based medicine evidence.

This study has potential limitations. First, the absence of a control group. Future randomized controlled trials should incorporate active comparator groups (e.g., dry needling or placebo) to better elucidate the therapeutic mechanisms. Second, despite emerging modalities such as thermography, electromyography, and muscle stiffness assessments that have improved diagnostic precision for MPS [47–49], our study primarily relied on subjective clinical evaluations. Future studies should prioritize larger-scale randomized controlled trials incorporating objective biomarkers (e.g., sEMG) to optimize diagnostic and therapeutic protocols for MPS.

Conclusion

In the present study, ultrasound-guided PRP regenerative treatment could obviously mitigate the myofascial trigger point-induced pain, improved the physical function and quality of life in the individuals of MPS individuals. There were no adverse reactions during the 3-month follow-up. The efficacy of PRP treatment could have the potential to last in a long-term period. These findings provide a foundation for the treatment of MPS with PRP regenerative therapy, holding significant implications for the subsequent translation of PRP technology. This study demonstrated that PRP might be an effective and safety treatment strategy to inactive the MTrP in treating MPS, which will facilitate the transformation of novel regenerative technology for MPS in the future.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

SA and XY conceptualized and designed the study. XX and YL collected and organized the data. XZ performed the data analysis and provided statistical support. HJ conducted the literature review and assisted with manuscript drafting. SA and XY wrote the original draft of the manuscript, while XX, YL, and HJ contributed to the revision and editing. HH and QW supervised the study and provided overall guidance. All authors read and approved the final manuscript.

Funding

This study was sponsored by the National Natural Science Foundation of China (82302884); Science & Technology Department of Sichuan Province (2022NSFSC1312).

Data availability

The data contained in the article is uploaded to the supplement in Excel format.

Declarations

Ethics approval and consent to participate

This study was approved by the Biomedical Research Ethics Committee of West China Hospital of Sichuan University No. 2023 (633) and Clinical Trial Registration No. ChiCTR2300074199 registered in 2023.8.1. The study adheres to the ethical guidelines set forth by the Declaration of Helsinki. Each participant was provided with comprehensive information about the study’s purpose, procedures, and potential risks. They were given the opportunity to ask questions and ensure they understood the study before consenting to participate.

Consent for publication

Written patient consent was obtained for publication of all aspects of the case including personal and clinical details and images, which may compromise anonymity.

Competing interests

The authors declare no competing interests.