Influência de alterações na musculatura esquelética na recuperação da marcha, em 3 meses após a fratura de fêmur proximal em idosos
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2024-02-02
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Universidade Estadual Paulista (Unesp)
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Introdução: O envelhecimento da população e a melhora da expectativa de vida são acompanhados do aumento de doenças crônicas não transmissíveis, como por exemplo, a osteoporose. As quedas em idosos são frequentes e levam a fratura por fragilidade óssea, sendo a mais grave e debilitante a fratura de fêmur proximal. Aproximadamente 50% dos pacientes não recuperam a marcha após esse tipo de trauma. O estudo de fatores que influenciam na recuperação da marcha são escassos, portanto se faz necessário investigar fatores que podem guiar diferentes estratégias de reabilitação. Objetivo: Avaliar se a perda de massa magra e/ou da função muscular na internação, ou 30/45 dias após a fratura, avaliadas pelo ultrassom, associam-se com a recuperação da marcha em ate 90 dias da fratura de fêmur. Métodos: Os pacientes internados com diagnóstico de fratura de fêmur proximal foram avaliados quanto espessura dos músculos reto femoral+vasto intermédio (RF) e vasto lateral+vasto intermedio (VL) pela ultrassonografia, a força muscular foi avaliação pela força de preensão manual e a mobilidade pelo escore de Parker e Palmer. As avaliações foram realizadas até as primeiras 72h de internação (M1); o ultrassom foi realizado no dia da alta (M2) e todas as avaliações repetidas em (M3) 30/45 dias pós alta. O escore de Parker e Palmer foi aplicado com 90dias (M4). Resultados: A maioria dos pacientes (83%) foram do sexo feminino com a média de idade de 80,37 ± 9,1 anos. A espessura do RF e VL se mantiveram entre o M1 e M2. A espessura do RF diminuiu entre o M1 e M3 e M2 e M3. A força de preensão muscular (FPM) foi semelhante entre os momentos M1 e M3. O escore de Parker e Palmer piorou entre o M1 e M4 [6,12 ±0,39 para 2,01±0,48 (P<,001)], porém essa piora não sofreu influência da espessura do RF e da realização da reabilitação em um dos modelos estudados. Houve uma tendência para que a diminuição do reto femoral interferisse com a piora do escore de mobilidade (P=0,056). A piora do escore de mobilidade sofreu influencia da FPM e da reabilitação no modelo que envolveu essas duas variáveis. Discussão e Conclusão: A diminuição da espessura do musculo RF não acontece durante a hospitalização, mas sim depois que o paciente vai de alta. A realização da reabilitação se mostrou efetiva no modelo em que a FPM foi considerada mas não no modelo isolado ou com a presença da espessura do RF. De qualquer forma, os dados deste trabalho, sugerem necessidade de mais estudos, sobre a intensidade, frequência e tipo de reabilitação ideal para auxiliar na recuperação da mobilidade após a fratura de fêmur proximal. É possível que intervenções para manter a massa do reto femoral seja uma via útil para também melhorar a mobilidade.
Introduction: The aging of the population and the improvement in life expectancy are accompanied by an increase in chronic non-commumnicable diseses, such as osteoporosis. Falls in the elderly are frequent and lead to fractures due to bone fragility, the most serious and debilitating being fractures of the proximal femur. Approximately 50% of patients do not regain walking after this type of trauma. The study of factores that influence gait recovery is scarce, therefore it is necessary to investigate factores that can guide different rehabilitation strategies. Objective: To evaluate whether the loss of lean mass and/or muscle function upon admission, or 30/45 days after the fracture, assessed by US, is associated with recovery of gait within 90 days of the femur fracture. Methods: Patients hospitalized with a diagnosis of fracture of the proximal femur were evaluated for thickness of the rectus femoris+vastus intermedius (RF) and vastus lateralis+vastus intermedius (VL) muscles by ultrasound, muscle strength was assessed by handgrip strength and mobility using the Parker and Palmer score. Assessments were carried out within the first 72 hours of hospitalization (M1); US was performed on the day of discharge (M2) and all assessments were repeated on (M3) 30/45 days’ post-discharge. The Parker and Palmer score was applied at 90 days (M4). Results: The majority of patients (83%) were female with a mean age of 80,37 ± 9,1 years. The thickness of the RF and VL remained between M1 and M2. RF thickness decreased between M1 and M3 and M2 and M3. Muscle grip strength (HGS) was similar between moments M1 and M3. The Parker and Palmer score worsened between M1 and M4 M4 [6,12 ±0,39 to 2,01±0,48 (P<,001)], but this worsening was not influenced by the thickness of the RF and the performance of the rehabilitation in one of the models studied. There was a tendency for the reduction of the rectus femoris to interfere with the worsening of the mobility score (P=0.056). The worsening of the mobility score was influenced by HGS and rehabilitation in the model that involved these two variables. Discussion and Conclusion: The decrease in RF muscle thickness does not occur during hospitalization, but rather after the patient is discharged. Rehabilitation was effective in the model in which HGS was considered, but not in the isolated model or with the presence of RF thickness. In any case, the data from this work suggest the need for further studies on the intensity, frequency and type of ideal rehabilitation to assist in the recovery of mobility after proximal femur fracture. It is possible that interventions to maintain rectus femoris mass could be a useful way to also improve mobility.
Introduction: The aging of the population and the improvement in life expectancy are accompanied by an increase in chronic non-commumnicable diseses, such as osteoporosis. Falls in the elderly are frequent and lead to fractures due to bone fragility, the most serious and debilitating being fractures of the proximal femur. Approximately 50% of patients do not regain walking after this type of trauma. The study of factores that influence gait recovery is scarce, therefore it is necessary to investigate factores that can guide different rehabilitation strategies. Objective: To evaluate whether the loss of lean mass and/or muscle function upon admission, or 30/45 days after the fracture, assessed by US, is associated with recovery of gait within 90 days of the femur fracture. Methods: Patients hospitalized with a diagnosis of fracture of the proximal femur were evaluated for thickness of the rectus femoris+vastus intermedius (RF) and vastus lateralis+vastus intermedius (VL) muscles by ultrasound, muscle strength was assessed by handgrip strength and mobility using the Parker and Palmer score. Assessments were carried out within the first 72 hours of hospitalization (M1); US was performed on the day of discharge (M2) and all assessments were repeated on (M3) 30/45 days’ post-discharge. The Parker and Palmer score was applied at 90 days (M4). Results: The majority of patients (83%) were female with a mean age of 80,37 ± 9,1 years. The thickness of the RF and VL remained between M1 and M2. RF thickness decreased between M1 and M3 and M2 and M3. Muscle grip strength (HGS) was similar between moments M1 and M3. The Parker and Palmer score worsened between M1 and M4 M4 [6,12 ±0,39 to 2,01±0,48 (P<,001)], but this worsening was not influenced by the thickness of the RF and the performance of the rehabilitation in one of the models studied. There was a tendency for the reduction of the rectus femoris to interfere with the worsening of the mobility score (P=0.056). The worsening of the mobility score was influenced by HGS and rehabilitation in the model that involved these two variables. Discussion and Conclusion: The decrease in RF muscle thickness does not occur during hospitalization, but rather after the patient is discharged. Rehabilitation was effective in the model in which HGS was considered, but not in the isolated model or with the presence of RF thickness. In any case, the data from this work suggest the need for further studies on the intensity, frequency and type of ideal rehabilitation to assist in the recovery of mobility after proximal femur fracture. It is possible that interventions to maintain rectus femoris mass could be a useful way to also improve mobility.
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Fratura proximal de femur, Ultrassonorafia, Força muscular