Minimising bone mineral density loss in traumatic amputees: a randomised controlled feasibility trial

最近在伊拉克和阿富汗发生的冲突导致大量创伤性或外科手术截肢。道路交通事故还会造成多人四肢受伤(32%)，包括截肢。截肢后髋部骨密度(BMD)降低，增加截肢髋部骨折的风险。截肢者人数下降的风险更高，更是雪上加霜。以前在平行临床人群中的干预已经证明了运动干预在恢复骨密度丢失方面的有效性。然而，这些类型的运动干预还没有在截肢者中尝试过。截肢者的骨密度丢失似乎是局部的和机械性的，需要生物力学方面的干预。因此，有必要立即对生物力学干预措施的有效性进行调查，以最大限度地减少这一人群的骨密度损失。为了在没有直接证据的情况下设计干预措施，德尔菲法--一种涉及该领域专家的共识方法--将提供一种已在文献中广泛应用的系统方法。随后，这将为一项随机对照可行性试验提供信息，以评估运动干预在该人群中的可接受性，以将骨密度损失降至最低。因此，这项研究旨在设计和实施一项随机对照的可行性研究，以减少创伤后下肢截肢患者的骨密度损失。

Recent conflicts in Iraq and Afghanistan have resulted in a large amount of traumatic or surgical lower limb amputations. Road traffic accidents also produce several extremity injuries (32%), including amputations. Hip bone mineral density (BMD) is reduced following amputation, increasing the risk of hip fractures on the amputated limb. This is compounded by a higher risk of falls in the amputee population. Previous interventions in parallel clinical populations have demonstrated the effectiveness of exercise interventions in recovering BMD loss. However, these types of exercise interventions have not been attempted in the amputee population. BMD loss in amputees appears to be local and mechanical in nature, requiring biomechanically informed interventions. Therefore, immediate investigation on the effectiveness of biomechanically informed interventions to minimise BMD loss in this population is required. To design an intervention where no direct evidence exists, a Delphi process, a consensus method involving experts in the area, would offer a systematic approach that has been applied in the literature extensively. Subsequently, this would inform a randomised controlled feasibility trial to assess the acceptability of an exercise intervention in this population to minimise BMD loss. Consequently, this study aims to design and implement a randomised controlled feasibility study to reduce bone mineral density loss in post-traumatic lower limb amputees.