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Previous issue date: 2015-03-23 / Traumatic Spinal Cord Injury (TSCI) is one of the most incident pathology that causes irreversible physical sequels in young people. As TSCI patient?s life expectancy increases, they also end up living longer with the comorbidities that involve the spinal cord injury. One of the major secondary consequences involving TSCI is osteoporosis, which makes fractures by imminent trauma more frequent. This aggravates the health and causes the treatment to be expensive. The loss of bone mass in the spinal injured is not yet established in the literature. However, some factors have been linked to its protection or risk, yet the studies are controversial. Thus, there is no consensus about it. Moreover, the function of the biochemical parameters that are involved in the bone metabolism were not defined either, as well the rehabilitation therapies able to stop bone loss. As a result, in this controlled cross-sectional lineation research, we studied the possible risk/protection factors for the low bone mass density (BMD) in 57 men with TSCI, older than 18 years old. Factors connected to health, lifestyle, and physiotherapy were highlighted throughout a questionnaire. Lab analysis were carried out to characterize parameters such as parathyroid hormone, calcium, vitamin D, urea, and creatinine. The bone density was utilized to verify the individuals? bone mass. After the data collection, the sample was divided between two groups, according to their bone mass: 38 were placed in this case group, BMD (z-score? -2,0DP), and 19 were placed in the control group, without BMD (z-score>-2,0DP). The collected variables were related to both denouements.Lastly, we found that the majority of subjects (66.6%) presented BMD in at least one of the three sites of interest studied (total body, lumbar spine and/or proximal femur). The total femur site was the one that presented more prevalence of BMD (45.5%). Inside this site, the sub-regions of intertrochanteric area and femoral neck presented a medium BMD in the studied population. The average serum levels of Vitamin D were localized in the insufficient range and there was no association among the biochemical parameters averages and the BMD of these individuals. After the adjust of confusion factors, three of these presented associations according to the variables associated to the BMD: the type of complete lesion (PR:1-0,76 CI 90%: 0,57-1,02), the Index of body mass (PR:1- 0,93 CI 90%: 0.89 ? 0.98 ), and the walking training (PR:10,45 CI 90% 0,20 ? 1,01). Thus, we can verify that people with incomplete TSCI have 24% of protection for BMD when compared to complete TSCI patients. For each BMI unit increasing there is a 7% protection for BMO; and patients that reported performing gait training during physiotherapy have 55% of protection for BMD when compared to patients that never did it. / A Les?o da Medula Espinhal por Traumatismo (LMET) ? uma das patologias de maior incid?ncia que causa sequelas f?sicas irrevers?veis em jovens. Com o aumento da expectativa de vida das pessoas com LMET, esses indiv?duos acabam por conviver por mais tempo com as comorbidades envolvidas com o trauma raquimedular. Uma das principais consequ?ncias secund?rias ? LMET ? a osteoporose, a qual torna o risco de fraturas por pequenos traumas iminente, acarretando em agravamento de sa?de e custos elevados para o seu tratamento. A instala??o da perda de massa ?ssea acentudada nos lesados medulares ainda n?o est? bem estabelecida na literatura, sendo que alguns fatores j? foram ligados ? sua prote??o ou risco, por?m os estudos s?o controversos, n?o havendo um consenso a respeito disso. Da mesma forma, o papel dos par?metros bioqu?micos envolvidos no metabolismo ?sseo tamb?m n?o foi bem definido, assim como as terapias de reabilita??o capazes de frear esta perda ?ssea. Assim, nesta pesquisa de delineamento transversal controlado estudamos os poss?veis fatores de risco ou prote??o para baixa massa ?ssea (BMO) em 57 homens com LMET e idade superior a 18 anos. Fatores ligados ? sa?de, estilo de vida e tratamento de fisioterapia foram levantados atrav?s de um question?rio. An?lises laboratoriais foram realizadas para caracterizar par?metros como paratorm?nio, c?lcio, vitamina D, ureia e creatinina. A densitometria ?ssea foi utilizada para verificar a massa ?ssea dos indiv?duos.Ap?s a coleta, a amostra foi dividida em dois grupos de acordo com sua massa ?ssea: 38 foram alocados no grupo caso, com BMO (z-score? -2,0DP), e 19 foram alocados no grupo controle, sem BMO (z-score>-2,0DP). As vari?veis coletadas foram relacionadas com ambos os desfechos. Por fim, encontramos que a maioria dos sujeitos (66,6%) apresentou BMO em pelo menos um dos tr?s s?tios de interesse estudados (corpo total, coluna lombar e/ou f?mur proximal). O s?tio de f?mur total foi o que apresentou maior preval?ncia de BMO (45,5%), sendo que, dentro deste s?tio, as sub-regi?es de zona intertrocant?rica e colo do f?mur apresentaram BMO em m?dia na popula??o estudada. Os valores s?ricos m?dios de Vitamina D estavam situados na faixa de insufici?ncia e n?o houve associa??o entre as m?dias dos par?metros bioqu?micos e a BMO destes indiv?duos. Quanto ?s vari?veis associadas ? BMO, ap?s ajuste de fatores de confus?o, tr?s destas apresentaram associa??es: o tipo de les?o completa (RP:1-0,76 IC 90%: 0,57-1,02), o ?ndice de massa corporal (RP:1- 0,93 IC 90%: 0.89 ? 0.98) e o treino de marcha (RP:10,45 IC 90% 0,20 ? 1,01). Com isso, verificamos que pessoas com LMET incompleta possuem 24% de prote??o para BMO em rela??o aos com LMET completa; a cada unidade de aumento do IMC h? uma prote??o de 7% para BMO; e pacientes que relataram realizar treino de marcha durante a fisioterapia possuem 55% de prote??o para BMO em rela??o aos pacientes que nunca realizaram esse treino.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/5949 |
| Date | 23 March 2015 |
| Creators | Kaminski, Elisa Lettnin |
| Contributors | Silva Filho, Ir?nio Gomes da, Schneider, Rodolfo Heberto |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Faculdade de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | 7620745074616285884, 600, 600, 600, -8624664729441623247, -969369452308786627 |
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