Ikumi Akira, Funayama Toru, Terajima Sho, Matsuura Satoshi, Yamaji Akihiro, Nogami Yuko, Okuwaki Shun, Kawamura Haruo, Yamazaki Masashi
Department of Orthopedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Japan.
Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba, Japan.
J Rural Med. 2021 Jan;16(1):8-13. doi: 10.2185/jrm.2020-036. Epub 2021 Jan 5.
Osteoporotic vertebral fracture (OVF) is conventionally treated with conservative management such as bed rest, but a relatively prolonged bed rest has the potential risk of muscle disuse atrophy. This study aimed to examine whether the 2-week of rigorous bed rest affects muscle disuse atrophy in OVF patients. A total of 54 OVF patients (16 males; 38 females; mean age, 80.2 ± 9.2 years) were treated with an initial 2-week rigorous bed rest by hospitalization with persistent rehabilitation. Cognitive function, swallowing function, grip strength, and lower extremity circumference were evaluated at three-time points (admission, end of bed rest, and discharge). Of the 51 patients who were able to walk independently before the injury, one patient (2.0%) had to use a wheelchair after the injury. During hospitalization, cognitive function decline was observed in 33.3% of patients, but not in patients with Revised Hasegawa's Dementia Scale score ≥25 at admission. Swallowing function decline was observed in one patient, and none of the patients developed aspiration pneumonia during hospitalization. The grip strength significantly improved both at the end of bed rest (=0.04) and discharge (=0.02). Although the lower extremity circumference significantly decreased at the end of bed rest (<0.01), it was recovered afterward. The lower extremity circumference did not significantly differ between the admission and discharge (=0.17). Our results suggested that conservative treatment of OVF through an initial 2-week rigorous bed rest with persistent hospital rehabilitation poses a low risk of muscle disuse atrophy. If cognitive dysfunction is observed on admission, close monitoring for exacerbation should be performed during the hospital stay.
骨质疏松性椎体骨折（OVF）传统上采用卧床休息等保守治疗方法，但较长时间的卧床休息存在肌肉废用性萎缩的潜在风险。本研究旨在探讨为期2周的严格卧床休息是否会影响OVF患者的肌肉废用性萎缩。共有54例OVF患者（男性16例；女性38例；平均年龄80.2±9.2岁）通过住院并持续康复接受了为期2周的初始严格卧床休息治疗。在三个时间点（入院时、卧床休息结束时和出院时）评估认知功能、吞咽功能、握力和下肢周长。在51例受伤前能够独立行走的患者中，有1例患者（2.0%）受伤后不得不使用轮椅。住院期间，33.3%的患者出现认知功能下降，但入院时修订版长谷川痴呆量表评分≥25分的患者未出现认知功能下降。有1例患者出现吞咽功能下降，住院期间无患者发生吸入性肺炎。握力在卧床休息结束时（=0.04）和出院时（=0.02）均显著改善。虽然卧床休息结束时下肢周长显著减小（<0.01），但随后恢复。入院时和出院时下肢周长无显著差异（=0.17）。我们的结果表明，通过为期2周的严格卧床休息并持续住院康复对OVF进行保守治疗，肌肉废用性萎缩的风险较低。如果入院时观察到认知功能障碍，住院期间应密切监测病情是否加重。
