BeDell K K, Scremin A M, Perell K L, Kunkel C F
Physical Medicine and Rehabilitation Service, West Los Angeles Department of Veterans Affairs Medical Center, CA 90073, USA.
Am J Phys Med Rehabil. 1996 Jan-Feb;75(1):29-34. doi: 10.1097/00002060-199601000-00008.
Spinal cord-injured (SCI) patients are at increased risk for fractures secondary to neurogenic osteoporosis. Earlier research claimed physical conditioning resulted in a decreased incidence or reversal of neurogenic osteoporosis. This study evaluated the effects of functional electrical stimulation-induced lower extremity cycling (FESILEC) on the bone densities of SCI patients using dual-energy x/ray absorptiometry (DEXA). The study consisted of 12 healthy male SCI patients, aged 23 to 46 (x +/- SD, 34 +/- 6) yr. The patients were post-traumatic, complete, spastic SCI; time postinjury ranged from 2 to 19 (9.7 +/- 5.1) yr. Patients participated in a three-phase training program. Phase 1 consisted of quadriceps strengthening. Phase 2 consisted of progressive sequential stimulation of quadriceps, hamstrings, and gluteal muscles, achieving a rhythmical pedaling motion on the REGYS I ergometer. Phase 3a consisted of 30-min FESILEC sessions. DEXAs were done at baseline and at completion of Phase 3a and Phase 3b. Bone densities were done of the lumbar spine levels 2-4 (L2-4), bilateral trochanters (T), Ward's triangles (WT) and femoral necks (FN). Baseline bone density indicated no difference between L2-4 of ambulatory males and SCI males. Baseline values obtained for T, WT, and FN were, respectively, 71, 82, and 79% of ambulatory values. Results after completion of the Phase 3a training program indicated no statistically significant difference compared with baseline values. There was, however, a positive trend in the lumbar spine post-Phase 3a (L2-4, P=0.056). Eight patients continued the exercise program, using a combination of upper and lower extremity cycling (Phase 3b) for a longer period of time (25 +/- 9 wk). DEXAs done after Phase 3b indicated no change relative to baseline data or data post-Phase 3a. In conclusion, although FESILEC did not significantly increase bone density in the hip parameters of chronic SCI patients, a positive trend was observed in the lumbar spine. Further research with acute intervention, such as FESILEC during the first few months post-SCI, is warranted to further evaluate a treatment regimen to prevent or reduce neurogenic osteopenia.
脊髓损伤（SCI）患者因神经源性骨质疏松继发骨折的风险增加。早期研究称，体能训练可降低神经源性骨质疏松的发病率或使其逆转。本研究使用双能X线吸收法（DEXA）评估功能性电刺激诱导的下肢循环训练（FESILEC）对SCI患者骨密度的影响。该研究包括12名健康男性SCI患者，年龄在23至46岁（x±标准差，34±6）之间。患者为创伤后完全性痉挛性SCI；受伤时间为2至19年（9.7±5.1年）。患者参加了一个三阶段训练计划。第一阶段包括股四头肌强化训练。第二阶段包括对股四头肌、腘绳肌和臀肌进行逐步顺序刺激，在REGYS I测力计上实现有节奏的蹬踏动作。第三阶段a包括30分钟的FESILEC训练课程。在基线时以及第三阶段a和第三阶段b结束时进行DEXA检查。对腰椎2-4节段（L2-4）、双侧转子（T）、沃德三角（WT）和股骨颈（FN）进行骨密度检测。基线骨密度显示，可行走男性和SCI男性的L2-4之间无差异。T、WT和FN的基线值分别为可行走者值的71%、82%和79%。第三阶段a训练计划完成后的结果表明，与基线值相比无统计学显著差异。然而，第三阶段a后腰椎有上升趋势（L2-4，P=0.056）。8名患者继续进行运动计划，使用上肢和下肢循环训练相结合的方式（第三阶段b），持续更长时间（25±9周）。第三阶段b后进行的DEXA检查表明，与基线数据或第三阶段a后的数据相比无变化。总之，尽管FESILEC并未显著增加慢性SCI患者髋部参数的骨密度，但在腰椎观察到了上升趋势。有必要对急性干预进行进一步研究，例如在SCI后的头几个月进行FESILEC，以进一步评估预防或减少神经源性骨质减少的治疗方案。
