High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury
High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury
复制标题
DOI：
10.1016/j.bone.2008.03.004
复制
发表时间：
2008-07-01
期刊：
影响因子：
4.1
通讯作者：
Eser, Prisca
中科院分区：
文献类型：
--
作者：
Frotzler, Angela;Coupaud, Sylvie;Eser, Prisca
脊髓损伤（SCI）导致瘫痪肢体严重骨质流失并导致骨折风险增加。由于长骨骨折会导致合并症和生活质量下降，因此提高慢性 SCI 患者的骨强度非常重要。在这项前瞻性纵向队列研究中，我们研究了功能性电刺激 (FES) 诱导的高容量循环训练是否可以部分逆转慢性完全性 SCI 后腿部骨物质的损失。招募了 11 名运动感觉完全 SCI 参与者（平均年龄 41.9 +/- 7.5 岁；伤后 11.0 +/- 7.1 岁）。经过 14-7 周的 FES 肌肉调节初始阶段后，参与者平均每周进行 3.7 +/- 0.6 次 FES 循环训练，每次 58 +/- 5 分钟，在 12 个月内以每个人的最高功率输出进行训练。在肌肉调理前 (t(1)) 以及大容量 FES 循环训练 6 个月 (t(2)) 和 12 个月 (t(3)) 后，通过外周定量计算机断层扫描对腿部的骨骼和肌肉参数进行研究。12 个月的 FES 循环后，小梁和总骨矿物质密度 (BMD) 以及股骨远端骨骺的总横截面积显着增加 14.4 +/-分别为 21.1%、7.0 +/- 10.8% 和 1.2 +/- 1.5%。股骨干骨参数显示小幅但显着的下降，皮质 BMD 降低 0.4 +/- 0.4%，骨矿物质含量降低 1.8 +/- 3.0%，皮质厚度降低 1.5 +/- 2.1%。这些下降主要发生在 t(1) 和 t(2) 之间。胫骨中任何测量的骨参数均未发现显着变化。大腿的肌肉 CSA 显着增加了 35.5 +/- 18.3%，而小腿的脂肪 CSA 减少了 16.7 +/- 12.3%。我们的结果表明，大容量 FES 循环训练会导致瘫痪肢体发生特定部位的骨骼变化，主动负载股骨远端的骨参数增加，但被动负载胫骨的骨参数不会增加。因此，我们得出结论，高容量 FES 诱导的自行车训练具有临床意义，因为它可以部分逆转骨质流失，从而可以降低该骨折易发部位的骨折风险。 (C) 2008 Elsevier Inc. 保留所有权利。
Spinal cord injury (SCI) leads to severe bone loss in the paralysed limbs and to a resulting increased fracture risk thereof. Since long bone fractures can lead to comorbidities and a reduction in quality of life, it is important to improve bone strength in people with chronic SCI. In this prospective longitudinal cohort study, we investigated whether functional electrical stimulation (FES) induced high-volume cycle training can partially reverse the loss of bone substance in the legs after chronic complete SCI. Eleven participants with motor-sensory complete SCI (mean age 41.9 +/- 7.5 years; 11.0 +/- 7.1 years post injury) were recruited. After an initial phase of 14 7 weeks of FES muscle conditioning, participants performed on average 3.7 +/- 0.6 FES-cycling sessions per week, of 58 +/- 5 min each, over 12 months at each individual's highest power output. Bone and muscle parameters were investigated in the legs by means of peripheral quantitative computed tomography before the muscle conditioning (t(1)), and after six (t(2)) and 12 months (t(3)) of high-volume FES-cycle training.After 12 months of FES-cycling, trabecular and total bone mineral density (BMD) as well as total cross-sectional area in the distal femoral epiphysis increased significantly by 14.4 +/- 21.1%, 7.0 +/- 10.8% and 1.2 +/- 1.5%, respectively. Bone parameters in the femoral shaft showed small but significant decreases, with a reduction of 0.4 +/- 0.4% in cortical BMD, 1.8 +/- 3.0% in bone mineral content, and 1.5 +/- 2.1% in cortical thickness. These decreases mainly occurred between t(1) and t(2). No significant changes were found in any of the measured bone parameters in the tibia. Muscle CSA at the thigh increased significantly by 35.5 +/- 18.3%, while fat CSA at the shank decreased by 16.7 +/- 12.3%. Our results indicate that high-volume FES-cycle training leads to site-specific skeletal changes in the paralysed limbs, with an increase in bone parameters at the actively loaded distal femur but not the passively loaded tibia. Thus, we conclude that high-volume FES-induced cycle training has clinical relevance as it can partially reverse bone loss and thus may reduce fracture risk at this fracture prone site. (C) 2008 Elsevier Inc. All rights reserved.