Davison John, Miller Aspen, Leary Steven, Hasegawa Emiko, McCulley Steele, Glass Natalie, Grossman Ruth, Marsh J L, Willey Michael
Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
College of Osteopathic Medicine, Des Moines University, West Des Moines, Iowa, USA.
Iowa Orthop J. 2025;45(1):247-254.
The aim of this study was too quantify loss of skeletal muscle mass that occurs early after high energy trauma and determine the association with poor nutrition intake.
This prospective cohort study was completed at a midwest academic level 1 trauma center. Patients aged 18 - 55 years old with acute open fracture of the extremity/pelvis and/or two or more injured extremities treated with operative fixation were enrolled. Body composition was measured with bioelectrical impedance analysis at time of injury, 6 weeks, and 12 weeks after injury (Lean Body Mass (LBM), Skeletal Muscle Mass (SMM), Percent Body Fat (%BF)).Dietary intake was measured with the Vioscreen® survey at time of injury and at 3 months. Baseline to post-operative changes in body composition were evaluated using repeated measures generalized linear models (GLM). To determine whether body composition changes differed according to baseline protein insufficiency, subjects were grouped according to baseline protein insufficiency status (<0.8 g protein/Kg Bodyweight, y/n) and analyses were repeated with addition of a group*time interaction term to GLM models.
Twenty patients (male, n=16 (80%)), mean age 37.7 SD 12.4 years) from June 2021 - June 2022 were enrolled. Subjects lost significant LBM at 6 weeks (mean = -5.2kg SD5.6kg, p=0.0007), 12 weeks (mean = -5.3kg SD5.5 kg, p=0.0017), and 24 weeks (mean = -8.3kg SD 7.3kg, p=0.0037). and significant SMM at 6 weeks (mean= -3.0kg SD 3.3kg, p=0.0009), 12 weeks (mean = -3.1 kg SD 3.2 kg, p=0.0013) and 24 weeks (mean = -4.8kg SD 4.4kg, p= 0.0049). There was also a significant increase in %BF seen at follow-up (0.45% SD 0.16%, p<0.05). Five out of 20 subjects were protein deficient at the time of injury. Protein deficiency was not associated with loss of LBM or SMM.
This study documented significant loss of LBM and SMM and increases in %BF after high energy musculoskeletal trauma. Insufficient protein intake was not associated with greater loss of muscle mass in this small series. .
本研究的目的是量化高能创伤后早期发生的骨骼肌质量损失，并确定其与营养摄入不足的关联。
这项前瞻性队列研究在一家中西部学术水平为1级的创伤中心完成。纳入年龄在18 - 55岁之间、因肢体/骨盆急性开放性骨折和/或两个或更多受伤肢体接受手术固定治疗的患者。在受伤时、受伤后6周和12周，采用生物电阻抗分析测量身体成分（去脂体重（LBM）、骨骼肌质量（SMM）、体脂百分比（%BF））。在受伤时和3个月时，采用Vioscreen®调查测量饮食摄入量。使用重复测量广义线性模型（GLM）评估身体成分从基线到术后的变化。为了确定身体成分变化是否因基线蛋白质不足而不同，根据基线蛋白质不足状态（<0.8克蛋白质/千克体重，是/否）对受试者进行分组，并在GLM模型中添加组*时间交互项后重复分析。
2021年6月至2022年6月期间，共纳入20例患者（男性，n = 16（80%）），平均年龄37.7岁，标准差12.4岁）。受试者在6周时LBM显著下降（平均值 = -5.2千克，标准差5.6千克，p = 0.0007），12周时（平均值 = -5.3千克，标准差5.5千克，p = 0.0017），24周时（平均值 = -8.3千克，标准差7.3千克，p = 0.0037）。SMM在6周时显著下降（平均值 = -3.0千克，标准差3.3千克，p = 0.0009），12周时（平均值 = -3.1千克，标准差3.2千克，p = 0.0013），24周时（平均值 = -4.8千克，标准差4.4千克，p = 0.0049）。随访时%BF也显著增加（0.45%，标准差0.16%，p < 0.05）。20名受试者中有5名在受伤时蛋白质缺乏。蛋白质缺乏与LBM或SMM的损失无关。
本研究记录了高能肌肉骨骼创伤后LBM和SMM的显著损失以及%BF的增加。在这个小样本系列中，蛋白质摄入不足与更大的肌肉质量损失无关。
