Andrew George , Brendan M. Holderread , Bradley S. Lambert , Joshua D. Harris , Patrick C. McCulloch
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Primary outcomes included functional or physiologic measures of muscle atrophy or strength. Fourteen studies including 611 patients (224 males, 387 females) were analyzed. Three studies evaluated protein supplementation after ACL reconstruction (ACLR), 3 after total hip arthroplasty (THA), 5 after total knee arthroplasty (TKA), and 3 after surgical treatment of hip fracture. Protein supplementation showed beneficial effects across all types of surgery. The primary benefit was a decrease in muscle atrophy compared to placebo as measured by muscle cross sectional area. Multiple authors also demonstrated improved functional measures and quicker achievement of rehabilitation benchmarks. Protein supplementation has beneficial effects on mitigating muscle atrophy in the postoperative period following ACLR, THA, TKA, and surgical treatment of hip fracture. These effects often correlate with improved functional measures and quicker achievement of rehabilitation benchmarks. 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引用次数: 0
摘要
骨科手术后机械负荷减少,患者容易出现肌肉萎缩。本综述旨在评估是否有证据支持口服蛋白质补充剂有助于减少骨科手术后肌肉萎缩和/或改善患者预后。根据系统综述和元分析首选报告项目(PRISMA)进行了系统综述。在 PubMed (MEDLINE)、Embase、Scopus 和 Web of Science 中检索了评估骨科手术患者补充蛋白质或氨基酸情况的随机对照试验。两名研究人员使用相关的布尔运算独立进行了检索。主要研究结果包括肌肉萎缩或力量的功能或生理指标。共分析了 14 项研究,包括 611 名患者(224 名男性,387 名女性)。三项研究评估了前交叉韧带重建(ACLR)术后、全髋关节置换术(THA)术后、全膝关节置换术(TKA)术后和髋部骨折手术治疗后分别补充蛋白质的情况。补充蛋白质对所有类型的手术都有益处。与安慰剂相比,通过肌肉横截面积测量,蛋白质补充剂的主要益处是减少肌肉萎缩。多位作者的研究还表明,功能性指标有所改善,并能更快地达到康复基准。在前交叉韧带损伤(ACLR)、全膝关节置换术(THA)、全膝关节置换术(TKA)和髋部骨折手术治疗术后,补充蛋白质对减轻肌肉萎缩有好处。这些效果通常与功能改善和更快达到康复基准相关。还需要进一步的研究来评估蛋白质补充的长期效果,并建立针对特定人群的标准化方案,以最大限度地提高术后的治疗效果。
Post-operative protein supplementation following orthopaedic surgery: A systematic review
Decreased mechanical loading after orthopaedic surgery predisposes patients to develop muscle atrophy. The purpose of this review was to assess whether the evidence supports oral protein supplementation can help decrease postoperative muscle atrophy and/or improve patient outcomes following orthopaedic surgery. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). PubMed (MEDLINE), Embase, Scopus, and Web of Science were searched for randomized controlled trials that assessed protein or amino acid supplementation in patients undergoing orthopaedic surgery. Two investigators independently conducted the search using relevant Boolean operations. Primary outcomes included functional or physiologic measures of muscle atrophy or strength. Fourteen studies including 611 patients (224 males, 387 females) were analyzed. Three studies evaluated protein supplementation after ACL reconstruction (ACLR), 3 after total hip arthroplasty (THA), 5 after total knee arthroplasty (TKA), and 3 after surgical treatment of hip fracture. Protein supplementation showed beneficial effects across all types of surgery. The primary benefit was a decrease in muscle atrophy compared to placebo as measured by muscle cross sectional area. Multiple authors also demonstrated improved functional measures and quicker achievement of rehabilitation benchmarks. Protein supplementation has beneficial effects on mitigating muscle atrophy in the postoperative period following ACLR, THA, TKA, and surgical treatment of hip fracture. These effects often correlate with improved functional measures and quicker achievement of rehabilitation benchmarks. Further research is needed to evaluate long-term effects of protein supplementation and to establish standardized population-specific regimens that maximize treatment efficacy in the postoperative period.