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[膳食补充剂和乳清蛋白对前交叉韧带重建术后患侧肢体肌肉质量和力量的影响:一项系统评价]

[Effect of dietary supplements and whey protein on muscle mass and strength of the operated limb after anterior cruciate ligament reconstruction: a systematic review].

作者信息

Lapaeva A G, Tabakov R S, Tabakov S E, Miroshnikov A B, Smolensky A V

机构信息

Russian University of Sport "GTSOLIFK", 105122, Moscow, Russian Federation.

Fitness and Wellness Center "BrainHelp", 109044, Moscow, Russian Federation.

出版信息

Vopr Pitan. 2023;92(2):87-96. doi: 10.33029/0042-8833-2023-92-2-87-96. Epub 2023 Mar 1.

Abstract

Muscle weakness and atrophy of the quadriceps muscle after anterior cruciate ligament reconstruction may persist for up to 6 months after surgery and cause re-injury to the ipsilateral or contralateral limbs. Many authors state that adequate nutritional status during the rehabilitation period can contribute to faster postoperative recovery of muscle mass and strength of the lower limb, be an adjunct to exercise, or serve an alternative treatment strategy. of the research was to conduct a systematic review of the literature and evaluate the degree of influence of dietary supplements on muscle mass and strength of the operated limb after reconstruction of the anterior cruciate ligament (ACL). . The search for articles was carried out in international databases PubMed, Google Scholar, Cochrane Library. The time frame of the search was 22 years. To be included in the review, studies had to meet the PICOS criteria: participants were men and women over 18 years of age after ACL reconstruction; intervention - supplementation after and/or before and after ACL reconstruction; comparison - placebo group or no supplementary interventions; results - assessment of the dynamics of changes in muscle mass (cross-sectional area, muscle thickness or size of skeletal muscle fibers) and / or maximum strength (dynamic or isometric) of the operated limb; research design - randomized controlled trials (RCT). The quality of selected RCTs was assessed using the Cochrane Collaboration Risk of Bias (RoB 2) tool. . A total of 1397 articles were found after searching in the databases. This systematic review included 6 RCTs with a total number of patients 186. The following dietary supplements were used: leucine - 1 article, glucosam ine - 1 article, creatine - 1 article, vitamins E and C - 2 articles. One study evaluated the effect of whey protein supplementation in combination with neuromuscular electrical stimulation on isometric strength of the operated limb. When comparing the data of 3 groups in the pre- and postoperative periods, there were no statistically significant differences between the groups. When considering the protocols for taking dietary supplements based on creatine, glucosamine, vitamins E and C, none of the studies demonstrated statistically significant improvements in the parameters of maximum strength or muscle hypertrophy of the operated limb in the main groups compared with the control groups. Also, no results have been obtained indicating that these dietary supplements can slow down muscl e atrophy after surgery. In another study that evaluated the effect of leucine supplementation, by the end of the rehabilitation program, the muscle strength of the operated limb tended to increase more in the leucine group than in the placebo group, but without a statistically significant difference. At 10 cm from the patella, the femoral circumference of the operated limb in the leucine group increased more than in the placebo group, and the differences were statistically significant (р=0.009). Two studies were rated as high risk of bias, three as moderate risk, and one as low risk. . None of the supplements used had a statistically significant effect on the muscle strength of the operated limb after ACL reconstru ction. In terms of thigh muscle hypertrophy, the only significant improvement was associated with leucine supplementation and an increase in thigh circumference at a distance of 10 cm from the patella.

摘要

前交叉韧带重建术后股四头肌的肌肉无力和萎缩可能会在术后持续长达6个月,并导致同侧或对侧肢体再次受伤。许多作者指出,康复期间充足的营养状况有助于下肢肌肉量和力量更快地术后恢复,可作为运动的辅助手段,或作为一种替代治疗策略。本研究的目的是对文献进行系统综述,并评估膳食补充剂对前交叉韧带(ACL)重建术后手术肢体肌肉量和力量的影响程度。在国际数据库PubMed、谷歌学术、考克兰图书馆中进行文章检索。检索的时间范围是22年。要纳入该综述,研究必须符合PICOS标准:参与者为ACL重建术后18岁以上的男性和女性;干预措施——ACL重建术后和/或术前及术后进行补充;对照——安慰剂组或无补充干预;结果——评估手术肢体肌肉量(横截面积、肌肉厚度或骨骼肌纤维大小)和/或最大力量(动态或等长)的变化动态;研究设计——随机对照试验(RCT)。使用考克兰协作偏倚风险(RoB 2)工具评估所选RCT的质量。在数据库检索后共找到1397篇文章。该系统综述纳入了6项RCT,患者总数为186例。使用了以下膳食补充剂:亮氨酸——1篇文章,氨基葡萄糖——1篇文章,肌酸——1篇文章,维生素E和C——2篇文章。一项研究评估了乳清蛋白补充剂联合神经肌肉电刺激对手术肢体等长力量的影响。在比较术前和术后3组的数据时,各组之间没有统计学上的显著差异。在考虑基于肌酸、氨基葡萄糖、维生素E和C的膳食补充剂服用方案时,与对照组相比,没有一项研究表明主要组中手术肢体的最大力量或肌肉肥大参数有统计学上的显著改善。此外,也没有获得表明这些膳食补充剂可以减缓术后肌肉萎缩的结果。在另一项评估亮氨酸补充剂效果的研究中,到康复计划结束时,亮氨酸组手术肢体的肌肉力量比安慰剂组有更大的增加趋势,但没有统计学上的显著差异。在距髌骨10厘米处,亮氨酸组手术肢体的大腿周长比安慰剂组增加得更多,差异具有统计学意义(р=0.009)。两项研究被评为高偏倚风险,三项为中度风险,一项为低风险。所使用的补充剂均未对ACL重建术后手术肢体的肌肉力量产生统计学上的显著影响。就大腿肌肉肥大而言,唯一显著的改善与亮氨酸补充剂以及距髌骨10厘米处大腿周长的增加有关。

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