Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota.
Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa.
J Bone Joint Surg Am. 2022 May 4;104(9):759-766. doi: 10.2106/JBJS.21.01014. Epub 2022 Mar 14.
Postoperative complications and substantial loss of physical function are common after musculoskeletal trauma. We conducted a prospective randomized controlled trial to assess the impact of conditionally essential amino acid (CEAA) supplementation on complications and skeletal muscle mass in adults after operative fixation of acute fractures.
Adults who sustained pelvic and extremity fractures that were indicated for operative fixation at a level-I trauma center were enrolled. The subjects were stratified based on injury characteristics (open fractures and/or polytrauma, fragility fractures, isolated injuries) and randomized to standard nutrition (control group) or oral CEAA supplementation twice daily for 2 weeks. Body composition (fat-free mass [FFM]) was measured at baseline and at 6 and 12 weeks postoperatively. Complications were prospectively collected. An intention-to-treat analysis was performed. The relative risk (RR) of complications for the control group relative to the CEAA group was determined, and linear mixed-effects models were used to model the relationship between CEAA supplementation and changes in FFM.
Four hundred subjects (control group: 200; CEAA group: 200) were enrolled. The CEAA group had significantly lower overall complications than the control group (30.5% vs. 43.8%; adjusted RR = 0.71; 95% confidence interval [CI] = 0.55 to 0.92; p = 0.008). The FFM decreased significantly at 6 weeks in the control subjects (-0.9 kg, p = 0.0205), whereas the FFM was maintained at 6 weeks in the CEAA subjects (-0.33 kg, p = 0.3606). This difference in FFM was not seen at subsequent time points.
Our results indicate that CEAA supplementation has a protective effect against common complications and early skeletal muscle wasting after operative fixation of extremity and pelvic fractures. Given the potential benefits of this inexpensive, low-risk intervention, multicenter prospective studies in focused trauma populations are warranted.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
在发生肌肉骨骼创伤后，患者常出现术后并发症和大量身体功能丧失。我们开展了一项前瞻性随机对照试验，旨在评估条件必需氨基酸（CEAA）补充对接受手术内固定治疗的急性骨折成年人的并发症和骨骼肌质量的影响。
在一级创伤中心，我们纳入了骨盆和四肢骨折、需要手术内固定的成年人患者。根据损伤特征（开放性骨折和/或多发伤、脆性骨折、单一损伤）对患者进行分层，然后随机分配至标准营养组（对照组）或口服 CEAA 补充剂组，每天两次，持续 2 周。在基线、术后 6 周和 12 周测量身体成分（去脂体重 [FFM]）。前瞻性收集并发症。采用意向治疗分析。确定对照组与 CEAA 组之间并发症的相对风险（RR），并采用线性混合效应模型来模拟 CEAA 补充与 FFM 变化之间的关系。
共纳入 400 例患者（对照组 200 例，CEAA 组 200 例）。CEAA 组的总并发症发生率显著低于对照组（30.5% vs. 43.8%；调整 RR=0.71；95%置信区间 [CI]：0.55 至 0.92；p=0.008）。对照组在 6 周时 FFM 显著下降（-0.9 kg，p=0.0205），而 CEAA 组在 6 周时 FFM 保持不变（-0.33 kg，p=0.3606）。在随后的时间点未观察到 FFM 的这种差异。
我们的研究结果表明，CEAA 补充可预防四肢和骨盆骨折手术后常见并发症和早期骨骼肌丢失。鉴于这种廉价、低风险干预措施的潜在获益，需要在特定创伤人群中开展多中心前瞻性研究。
治疗性研究 1 级。欲了解完整的证据等级描述，请参阅《作者须知》。
