早期功能锻炼对脊髓损伤患者骨质疏松的预防作用

Early rehabilitation exercises in the prevention of osteoporosis in patients after spinal cord injury

目的探讨早期肢体被动功能锻炼对脊髓损伤患者骨质疏松的预防作用。方法将26例外伤性脊髓损伤所致截瘫患者随机分为实验组和对照组，每组13例，实验组进行早期肢体功能锻炼，对照组按照外伤瘫痪患者护理常规进行。常规x线片观察两组患者锻炼前后（入组时和4个月后）腰椎及股骨近端的松质骨密度变化，同时分别检测两组患者锻炼前后（入组时和4个月后）血清碱性磷酸酶、血钙、尿Ca／Cr及尿羟脯氨酸含量。结果腰椎及股骨近端的松质骨密度实测值与入组时比较，锻炼后（4个月后）两组均有下降趋势，但均无统计学意义（P〉0．05），两组间差异也无统计学意义（P〉0．05）。与入组时比较，锻炼后（4个月）实验组血清碱性磷酸酶无统计学差异（P〉0．05），血钙、尿Ca／Cr及尿羟脯氨酸均有统计学意义（P〈0．05）；对照组血清碱性磷酸酶血钙、尿Ca／Cr及尿羟脯氨酸均无统计学意义（P〉0．05）。锻炼后（4个月）两组间除血清碱性磷酸酶差异无统计学意义（P〉0．05），血钙、尿Ca／Cr及尿羟脯氨酸差异均有统计学意义（P〈0．05）。结论早期肢体功能锻炼对脊髓损伤患者骨质疏松具有一定的预防作用。

Objective To investigate the function of early rehabilitation exercise in the prevention of osteoporosis in patients after spinal cord injury. Methods 26 paraplegia patients caused by traumatic spinal cord injury were randomly divided into test group and control group （ 13 cases for each group）. Cases in test group received early rehabilitation exercises and cases in control group were treated with routine nursing about traumatic spinal cord injury. Patient＇s serum concentrations of ionized calcium, ALP, and urine concentrations of calcium, creatinine were performed at before and after exercise （into the group and 4 months later） and bone mineral density in lumbar vertebrae and proximal femur were measured with regularly X-ray plain radiograph at the same vertebral body. Results Compared with the period before exercise, the lumbar spine and proximal femur trabecular bone mineral density measured showed decreases in both groups but had not significant difference （P 〉 0. 05 ） after exercise （4 months ）. Differences between the two groups had not significant difference either （P 〉 0. 05 ）. Compared with the period before exercise, serum alkaline phosphatase had not significant difference （ P 〉 0.05 ） after exercise, while serum calcium, urinary Ca/Cr and urinary hydroxyproline had significant difference （P 〈 0. 05 ） ; In control group, serum alkaline phosphatase, serum calcium, urinary Ca/Cr and urinary hydroxyproline had not significant difference （P 〉 0. 05 ）. Serum calcium, urinary Ca/Cr and urinary hydroxyproline had significant difference （P 〈 0. 05 ） after exercise （4 months） between the two groups except serum alkaline phosphatase （ P 〉 0. 05 ）. Conclusions The results demonstrate that early positive rehabilitation exercise can prevent osteoporosis after spinal cord injury.