Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri.
Traffic Inj Prev. 2022;23(sup1):S86-S91. doi: 10.1080/15389588.2022.2124864. Epub 2022 Oct 3.
Quantify the independent and combined effects of abdominal muscle quantity and lumbar bone mineral density (BMD) on injury risk and in-hospital outcomes in severely injured motor vehicle crash (MVC) occupants ages 50 and older. Skeletal muscle area measurements of MVC occupants were obtained through semi-automated segmentation of an axial computed tomography (CT) slice at the L3 vertebra. An occupant height-normalized Skeletal Muscle Index (SMI) was calculated - a defining metric of sarcopenia and low muscle mass (sarcopenia thresholds: <38.5 cm/m females; <52.4 cm/m males). Lumbar BMD was obtained using a validated, phantomless CT calibration method (osteopenia threshold: <145 mg/cm). SMI and BMD values were used to categorize occupants, and logistic regression was used to associate sarcopenia, osteopenia, and osteosarcopenia predictors to injury outcomes (e.g., Injury Severity Score (ISS), maximum Abbreviated Injury Scale (MAIS) score, fractures) and hospital outcomes (e.g., length of stay, ICU days). Of the 336 occupants, 210 (63%) were female (mean ± SD: age 66.3 ± 10.6). SMI was 41.7 ± 8.0 cm/m in females and 51.2 ± 10.8 cm/m in males. Based on SMI, 40% of females and 55% of males were classified as sarcopenic. BMD was 163.2 ± 38.3 mg/cm in females and 164.1 ± 35.4 mg/cm in males, with 41% of females and 33% of males classified as osteopenic. Prevalence of both conditions (osteosarcopenia) was similar between females (21%) and males (22%). Incidence of low SMI and BMD increased with age. Sarcopenic individuals were less likely to sustain a MAIS 2+ thorax injury and had longer ICU stays. Osteopenic individuals were more likely to sustain upper extremity injuries and fractures, and were less likely to be discharged to a rehabilitation facility. Osteosarcopenic individuals were less likely to be ventilated or admitted to the ICU but tended to spend more time on the ventilator if placed on one. Osteosarcopenia was not associated with any injury outcomes, but sarcopenia was associated with thoracic injury and osteopenia was associated with upper extremity injury incidence. Sarcopenia was only associated with ICU length of stay, while osteopenia was only associated with discharge destination. Osteosarcopenia was associated with likelihood of being ventilated, being admitted to the ICU, and with increased length of ventilation.
定量分析腹部肌肉量和腰椎骨密度（BMD）对 50 岁及以上严重机动车碰撞（MVC）乘员受伤风险和住院结局的独立和综合影响。通过对 L3 椎骨的轴向计算机断层扫描（CT）切片进行半自动分割，获得 MVC 乘员的骨骼肌区域测量值。计算出乘员身高归一化骨骼肌指数（SMI）-肌少症和低肌肉量的定义指标（肌少症阈值：女性 <38.5cm/m；男性 <52.4cm/m）。使用经过验证的、无体模 CT 校准方法（骨质疏松阈值：<145mg/cm）获得腰椎 BMD。使用 SMI 和 BMD 值对乘员进行分类，并使用逻辑回归将肌少症、骨质疏松症和骨肌减少症预测因子与损伤结局（例如，损伤严重程度评分（ISS）、最大简明损伤评分（MAIS）评分、骨折）和住院结局（例如，住院时间、ICU 天数）相关联。在 336 名乘员中，210 名（63%）为女性（平均±标准差：年龄 66.3±10.6）。女性的 SMI 为 41.7±8.0cm/m，男性为 51.2±10.8cm/m。根据 SMI，40%的女性和 55%的男性被归类为肌少症。女性的 BMD 为 163.2±38.3mg/cm，男性为 164.1±35.4mg/cm，41%的女性和 33%的男性被归类为骨质疏松症。女性（21%）和男性（22%）的两种情况（骨肌减少症）患病率相似。低 SMI 和 BMD 的发生率随年龄增长而增加。肌少症患者发生 MAIS 2+胸部损伤和 ICU 入住时间较长的可能性较低。骨质疏松症患者发生上肢损伤和骨折的可能性较高，而被送往康复机构的可能性较低。骨肌减少症患者较少需要通气或入住 ICU，但如果需要通气，他们在呼吸机上的时间往往更长。骨肌减少症与任何损伤结局无关，但肌少症与胸部损伤相关，骨质疏松症与上肢损伤发生率相关。肌少症仅与 ICU 住院时间相关，而骨质疏松症仅与出院目的地相关。骨肌减少症与通气、入住 ICU 的可能性以及通气时间的增加相关。
