Hooper M M, Stellato T A, Hallowell P T, Seitz B A, Moskowitz R W
Arthritis Translational Research Program, University Hospitals of Cleveland, Cleveland, OH, USA.
Int J Obes (Lond). 2007 Jan;31(1):114-20. doi: 10.1038/sj.ijo.0803349. Epub 2006 Apr 25.
To determine the point prevalence of painful musculoskeletal (MSK) conditions in obese subjects before and after weight loss following bariatric surgery.
Longitudinal, interventional, unblended.
Forty-eight obese subjects (47 women, one man, mean age 44+/-9 years; mean body mass index (BMI) 51+/-8 kg/m(2)) recruited from an academic medical center bariatric surgery program.
Comorbid medical conditions; MSK findings; BMI; Western Ontario McMaster Osteoarthritis Index (WOMAC) for pain, stiffness and function; and SF-36 for quality of life.
Consecutive subjects were recruited from the University Hospitals of Cleveland Bariatric Surgery Program. Musculoskeletal signs and symptoms and non-MSK comorbid conditions were documented at baseline and at follow-up. SUBJECTS completed the SF-36 and the WOMAC questionnaires. Analyses were carried out for each MSK site, fibromyalgia syndrome (FMS) and for the cumulative effect on the spine, upper and lower extremities. The impact of change in comorbid medical conditions, BMI, physical and mental health domains of the SF-36 on the WOMAC pain subscale score was evaluated. SF-36 outcomes were compared to normal published controls.
Forty-eight subjects were available for baseline and a follow-up assessment 6-12 months after gastric bypass surgery. They lost an average of 41+/-15 kg and the mean BMI decreased from 51+/-8 to 36+/-7 kg/m(2). Baseline comorbid medical conditions were present in 96% before surgery and 23% after weight loss. There was an increased prevalence of painful MSK conditions at baseline compared to general population frequencies. Musculoskeletal complaints had been present in 100% of obese subjects before, and 23% after weight loss. The greatest improvements occurred in the cervical and lumbar spine, the foot and in FMS (decreased by 90, 83, 83 and 92%, respectively). Seventy-nine percent had upper extremity MSK conditions before and 40% after weight loss. Before surgery, 100% had lower extremity MSK conditions and only 37% did after weight loss. The WOMAC subscale and composite scores all improved significantly, as did the SF-36((R)). Change in BMI was the main factor impacting the WOMAC pain score.
There was a higher frequency of multiple MSK complaints, including non-weight-bearing sites compared to historical controls, before surgery, which decreased significantly at most sites following weight loss and physical activity. These benefits may improve further, as weight loss may continue for up to 24 months. The benefits seen with weight loss indicate that prevention and treatment of obesity can improve MSK health and function.
确定肥胖受试者在接受减肥手术后体重减轻前后疼痛性肌肉骨骼（MSK）疾病的点患病率。
纵向、干预性、非盲法。
从一家学术医疗中心的减肥手术项目中招募了48名肥胖受试者（47名女性，1名男性，平均年龄44±9岁；平均体重指数（BMI）51±8kg/m²）。
合并的内科疾病；MSK检查结果；BMI；用于评估疼痛、僵硬和功能的西安大略和麦克马斯特大学骨关节炎指数（WOMAC）；以及用于评估生活质量的SF-36。
从克利夫兰大学医院减肥手术项目中连续招募受试者。在基线和随访时记录肌肉骨骼体征和症状以及非MSK合并疾病。受试者完成SF-36和WOMAC问卷。对每个MSK部位、纤维肌痛综合征（FMS）以及对脊柱、上肢和下肢的累积影响进行分析。评估合并内科疾病、BMI、SF-36的身体和心理健康领域的变化对WOMAC疼痛子量表评分的影响。将SF-36的结果与已发表的正常对照组进行比较。
48名受试者可进行基线评估以及胃旁路手术后6 - 12个月的随访评估。他们平均减重41±15kg，平均BMI从51±8降至36±7kg/m²。术前96%的受试者存在基线合并内科疾病，减重后为23%。与一般人群频率相比，基线时疼痛性MSK疾病的患病率更高。100%的肥胖受试者术前存在肌肉骨骼主诉，减重后为23%。颈椎、腰椎、足部和FMS的改善最为显著（分别下降了90%、83%、83%和92%）。79%的受试者术前存在上肢MSK疾病，减重后为40%。术前100%的受试者存在下肢MSK疾病，减重后仅37%存在。WOMAC子量表和综合评分均显著改善，SF-36也是如此。BMI的变化是影响WOMAC疼痛评分的主要因素。
与历史对照组相比，术前存在多种MSK主诉的频率更高，包括非负重部位，减重和体育活动后大多数部位的此类主诉显著减少。随着体重减轻可能持续长达24个月，这些益处可能会进一步改善。体重减轻带来的益处表明，肥胖的预防和治疗可以改善MSK健康和功能。
