步行训练对外伤性脊髓损伤患者骨量丢失的影响

Effect of ambulation training on bone loss in patients with traumatic spinal cord injury

目的:通过观察骨密度和骨代谢相关指标的变化来评价步行训练防治外伤性脊髓损伤患者骨量丢失的临床疗效并探讨其作用机制。方法:选取23例外伤性脊髓损伤合并骨量丢失患者,随机分为观察组12例和对照组11例。2组均进行常规康复训练,观察组在此基础上进行步行训练。2组均每日治疗1次,连续治疗60d。治疗前、治疗1个月、治疗2个月分别测定患者的腰椎和股骨骨密度、抗酒石酸酸性磷酸酶5b(TRACP5b)、骨碱性磷酸酶(BALP)、25羟基维生素D[25(OH)D]、血钙、血磷、血清碱性磷酸酶(ALP)的变化情况。结果:治疗2个月后,观察组的TRACP5b治疗前后差异无统计学意义,对照组治疗2个月后TRACP5b值较治疗前明显升高(P<0.05),且观察组低于对照组(P<0.05)。治疗1及2个月后,2组患者的腰4椎体、腰1-腰4椎体骨密度均呈下降趋势,组内和组间比较,其差异并无统计学意义。治疗1及2个月后,2组患者的股骨颈、股骨全部骨密度均呈下降趋势(均P<0.05),对照组治疗2个月后和治疗前相比明显下降(均P<0.05)。治疗后1、2个月后,BALP、25(OH)D、血钙、血磷、ALP 5个指标组内及组间比较差异均无统计学意义。结论:步行训练能减轻外伤性脊髓损伤患者股骨颈和股骨全部骨密度下降的程度,但对损伤平面以下不同部位骨密度的影响不同,其作用机制可能和抑制骨吸收有关。

Objective： By observing the changes in bone mineral density （BMD） and bone metabolism-related indicators, to evaluate the clinical curative effect and discuss the mechanism of ambulation training preventing and treating bone loss after traumatic spinal cord injury. Methods： Twenty-three patients with bone loss after traumatic spinal cord injury were randomly divided into observation group （n=12） and control group （n=11）. Two groups were subjected to routine rehabilitation training and drugs. Additionally, the observation group received the ambulation training. The two groups were treated once a day, 10 days for a period of treatment and a total of 6 courses. Lum- bar spine and femoral BMD, tartrate resistant acid phosphatase 5b （TRACPSb）, bone alkaline phosphatase （BALP）, 25-hydroxyitamin D [25 （OH） D], blood calcium, blood phosphorus and alkaline phosphatase （ALP） were detected before, and 1 month and 2 months after treatment. Results： After treatment for 2 months, the TRACPSb in observation group was not significantly different before and after treatment. But the TRACPSb in control group was significantly higher than that before the treatment （P〈0.05）, and the observation group was lower than that in control group （P〈0.05）. After treatment for 1 and 2 months, bone mineral density of lumbar 4 vertebrae and lumbar 1- lumbar 4 vertebrae of two groups showed a downward trend, but the comparison between intra group or inter group was no different. After treatment for 1 and 2 months, femoral neck and all of femur BMD of two groups showed a downward trend, after 2 months, the femoral neck and femoral BMD of the control group dropped significantly before and after treatment （P〈0. 05）. After treatment for 1 and 2 months, comparison of BALP, 25（OH）D, Blood calcium, Blood phosphorus, ALP between intra group or inter group was no different. Conclusion ： Ambulation training can reduce the extent of the BMD decline in femoral neck and all of femur of the patients with traumatic spinal cord injury with different influences on different sublesional bones, which is probably related to inhibition of bone resorption.