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高运动量功能性电刺激辅助骑行可部分逆转慢性脊髓损伤患者的骨质流失。

High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury.

作者信息

Frotzler Angela, Coupaud Sylvie, Perret Claudio, Kakebeeke Tanja H, Hunt Kenneth J, Donaldson Nick de N, Eser Prisca

机构信息

Swiss Paraplegic Research, CH-6207 Nottwil, Switzerland.

Centre for Rehabilitation Engineering, Department of Mechanical Engineering, University of Glasgow, Glasgow, United Kingdom; Queen Elizabeth National Spinal Injuries Unit, Southern General Hospital, Glasgow, United Kingdom.

出版信息

Bone. 2008 Jul;43(1):169-176. doi: 10.1016/j.bone.2008.03.004. Epub 2008 Mar 20.

Abstract

Spinal cord injury (SCI) leads to severe bone loss in the paralysed limbs and to a resulting increased fracture risk thereof. Since long bone fractures can lead to comorbidities and a reduction in quality of life, it is important to improve bone strength in people with chronic SCI. In this prospective longitudinal cohort study, we investigated whether functional electrical stimulation (FES) induced high-volume cycle training can partially reverse the loss of bone substance in the legs after chronic complete SCI. Eleven participants with motor-sensory complete SCI (mean age 41.9+/-7.5 years; 11.0+/-7.1 years post injury) were recruited. After an initial phase of 14+/-7 weeks of FES muscle conditioning, participants performed on average 3.7+/-0.6 FES-cycling sessions per week, of 58+/-5 min each, over 12 months at each individual's highest power output. Bone and muscle parameters were investigated in the legs by means of peripheral quantitative computed tomography before the muscle conditioning (t1), and after six (t2) and 12 months (t3) of high-volume FES-cycle training. After 12 months of FES-cycling, trabecular and total bone mineral density (BMD) as well as total cross-sectional area in the distal femoral epiphysis increased significantly by 14.4+/-21.1%, 7.0+/-10.8% and 1.2+/-1.5%, respectively. Bone parameters in the femoral shaft showed small but significant decreases, with a reduction of 0.4+/-0.4% in cortical BMD, 1.8+/-3.0% in bone mineral content, and 1.5+/-2.1% in cortical thickness. These decreases mainly occurred between t1 and t2. No significant changes were found in any of the measured bone parameters in the tibia. Muscle CSA at the thigh increased significantly by 35.5+/-18.3%, while fat CSA at the shank decreased by 16.7+/-12.3%. Our results indicate that high-volume FES-cycle training leads to site-specific skeletal changes in the paralysed limbs, with an increase in bone parameters at the actively loaded distal femur but not the passively loaded tibia. Thus, we conclude that high-volume FES-induced cycle training has clinical relevance as it can partially reverse bone loss and thus may reduce fracture risk at this fracture prone site.

摘要

脊髓损伤(SCI)会导致瘫痪肢体出现严重的骨质流失,进而增加其骨折风险。由于长骨骨折会引发合并症并降低生活质量,因此提高慢性脊髓损伤患者的骨强度非常重要。在这项前瞻性纵向队列研究中,我们调查了功能性电刺激(FES)诱导的高强度循环训练是否能部分逆转慢性完全性脊髓损伤后腿部骨质的流失。招募了11名运动感觉完全性脊髓损伤的参与者(平均年龄41.9±7.5岁;受伤后11.0±7.1年)。在进行了14±7周的FES肌肉 conditioning初始阶段后,参与者在12个月内每周平均进行3.7±0.6次FES循环训练,每次训练58±5分钟,训练强度为个人最高功率输出。在肌肉 conditioning前(t1)、高强度FES循环训练6个月(t2)和12个月(t3)后,通过外周定量计算机断层扫描对腿部的骨骼和肌肉参数进行了研究。经过12个月的FES循环训练后,股骨远端骨骺的小梁骨和总骨矿物质密度(BMD)以及总横截面积分别显著增加了14.4±21.1%、7.0±10.8%和1.2±1.5%。股骨干的骨参数显示出虽小但显著的下降,皮质骨BMD降低了0.4±0.4%,骨矿物质含量降低了1.8±3.0%,皮质厚度降低了1.5±2.1%。这些下降主要发生在t1和t

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