Ekinci Osman, Yanık Serhat, Terzioğlu Bebitoğlu Berna, Yılmaz Akyüz Elvan, Dokuyucu Ayfer, Erdem Şevki
1 Department of Anesthesiology and Reanimation, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey.
2 Department of Orthopedics, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey.
Nutr Clin Pract. 2016 Dec;31(6):829-835. doi: 10.1177/0884533616629628. Epub 2016 Jul 9.
Nutrition support in orthopedic patients with malnutrition shortens the immobilization period. The efficacy of calcium β-hydroxy-β-methylbutyrate (CaHMB), vitamin D, and protein intake on bone structure is studied and well known; however, there is no evidence supporting the effect of combined use in orthopedic conditions. We investigated the effects of CaHMB, vitamin D, and protein supplementation on wound healing, immobilization period, muscle strength, and laboratory parameters.
This randomized controlled study included 75 older female patients with a hip fracture admitted to orthopedic clinics. The control group received standard postoperative nutrition. The study group received an enteral product containing 3 g CaHMB, 1000 IU vitamin D, and 36 g protein, in addition to standard postoperative nutrition. Anthropometric, laboratory, wound-healing, immobilization period, and muscle strength assessments were evaluated preoperatively and on postoperative days 15 and 30.
Wound-healing period was significantly shorter in the CaHMB/vitamin D/protein group than in the control group ( P < .05). The number of patients in the CaHMB/vitamin D/protein group who were mobile on days 15 and 30 (81.3%) was significantly higher than patients in the control group, who were mobile on days 15 and 30 (26.7%) ( P = .001). Muscle strength on day 30 was significantly higher in the CaHMB/vitamin D/protein group vs the control group.
Nutrition of elderly patients with a CaHMB/vitamin D/protein combination led to acceleration of wound healing, shortening of immobilization period, and increased muscle strength without changing body mass index. It also reduced dependence to bed and related complications after an orthopedic operation.
对营养不良的骨科患者进行营养支持可缩短固定期。钙β-羟基-β-甲基丁酸酯（CaHMB）、维生素D和蛋白质摄入对骨骼结构的影响已得到研究且广为人知；然而，尚无证据支持在骨科疾病中联合使用的效果。我们研究了补充CaHMB、维生素D和蛋白质对伤口愈合、固定期、肌肉力量和实验室指标的影响。
这项随机对照研究纳入了75名入住骨科门诊的老年女性髋部骨折患者。对照组接受标准的术后营养。研究组除接受标准术后营养外，还接受一种含有3克CaHMB、1000国际单位维生素D和36克蛋白质的肠内产品。术前以及术后第15天和第30天对人体测量、实验室检查、伤口愈合、固定期和肌肉力量进行评估。
CaHMB/维生素D/蛋白质组的伤口愈合期明显短于对照组（P <.05）。CaHMB/维生素D/蛋白质组在第15天和第30天能够活动的患者数量（81.3%）显著高于对照组在第15天和第30天能够活动的患者数量（26.7%）（P =.001）。与对照组相比，CaHMB/维生素D/蛋白质组在第30天的肌肉力量明显更高。
老年患者采用CaHMB/维生素D/蛋白质联合营养可加速伤口愈合、缩短固定期并增加肌肉力量，而不改变体重指数。它还减少了骨科手术后对卧床的依赖及相关并发症。
