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Preventive strategies for muscle atrophy after bone plate fixation
After bone plate fixation, due to long-term immobilization of the limb, pain, inflammatory response and inhibition of nerve function, significant muscle atrophy (reduced muscle fiber diameter and decreased muscle strength) can occur within 2 to 4 weeks after the operation. Early intervention and systematic training are needed to reverse or delay the atrophy process. The following are the core measures for preventing muscle atrophy, covering mechanism understanding, training plans, nutritional support and auxiliary means.
First, the mechanism of muscle atrophy
Braking atrophy
The mechanical load that muscles bear every day decreases, leading to a reduction in muscle protein synthesis and an increase in its decomposition. As a result, the diameter of muscle fibers can shrink by 10% to 15% within two weeks.
Example: After a knee fracture and plaster fixation for 6 weeks, the strength of the quadriceps femoris may drop to 30%-50% of the normal value.
Neuromuscular function inhibition
Pain and inflammatory stimuli inhibit muscle contraction through spinal reflexes, resulting in a reduction in the recruitment of motor units and a decrease in muscle activation efficiency.
Metabolic disorder
After braking, the blood flow to the muscles decreases, and the supply of oxygen and nutrients is insufficient, further accelerating the degeneration of muscle fibers.
Second, early intervention measures (0-2 weeks after surgery)
Isometric contraction training (muscle “tension” exercise)
Method: Within a painless range, actively contract the target muscles (such as tensing the muscles in the front of the thighs), hold for 5 to 10 seconds and then relax. Do 3 to 5 sets daily, with 10 to 15 repetitions per set.
Principle: Isometric contraction does not cause joint movement, but it can maintain muscle tone and stimulate muscle protein synthesis.
Applicable sites: Adjacent muscles in the fixation area of limb fractures (such as the quadriceps and biceps brachii).
Neuromuscular electrical stimulation (NMES)
Method: Apply low-frequency current (frequency 20-50Hz) to the target muscle through electrode patches to induce muscle contraction. Do this once a day for 20 minutes each time.
Advantages: It directly activates the muscles without bypassing the central nervous system and is suitable for patients with obvious early postoperative pain or difficulty in active contraction.
Precautions: The current intensity should be within the patient’s tolerance to avoid causing discomfort.
Passive joint movement
Method: Perform joint flexion and extension with the assistance of others or using a CPM machine, 3 to 5 times a day, for 10 to 15 minutes each time.
Function: Promote the secretion of synovial fluid in joints, reduce adhesions, and indirectly maintain muscle length and tension.
Third, mid-term intensive training (2 to 6 weeks after the operation)
Isotonic contraction training (resistance practice)
Method: Use resistance bands or light dumbbells for progressive resistance training (such as straight leg raises and sitting leg raises), 8 to 12 times per set, 2 to 3 sets per day.
Principle: Start with low resistance and high repetition rates, increasing the resistance by 5% to 10% each week to avoid overloading.
Quadriceps training can be transitioned from body weight (such as sitting leg raises) to resistance with an elastic band.
Closed Kinetic Chain Exercises
Method: Perform multi-joint coordinated movements (such as wall squats and tiptoe walking) to enhance muscle coordination and stability.
Advantages: It is closer to the daily activity pattern and reduces joint pressure.
Core muscle group training
Method: Core training such as plank and bridge exercise can be carried out 4 weeks after the operation. Do 2 sets every day, and each set lasts for 30 seconds.
Function: Enhance the stability of the trunk and provide a foundation for the recovery of limb function.
Fourth, long-term functional recovery (6 weeks after the operation)
Functional training
Lower limbs: Stand on one leg, go up and down stairs, jog slowly, etc., gradually restore balance and motor control ability.
Upper limbs: Throwing and catching balls, pushing dumbbells, etc., to enhance the coordination and strength of the upper limbs.
Aerobic exercise
Method: Low-impact exercises such as swimming and cycling, 3 to 4 times a week, for 20 to 30 minutes each time.
Function: Improve heart and lung function, promote overall metabolism, and indirectly support muscle recovery.
Flexibility training
Method: Static stretching (such as quadriceps stretching and hamstring stretching) was performed starting from 8 weeks after the operation, holding for 30 seconds each time, 2-3 times a day.
Function: Maintain the extensibility of muscles and tendons and reduce the risk of sports injuries.
Fifth, nutrition and auxiliary support
Protein intake
Recommended intake: 1.2-1.5g/kg of body weight per day, with high-quality protein (such as eggs, fish, and soy products) accounting for more than 50%.
Principle: Protein is the raw material for muscle protein synthesis, and its demand increases during braking.
Antioxidant supplementation
Recommended nutrients: Vitamin C (1000mg daily), Vitamin E (400IU daily), omega-3 fatty acids (1-2g daily).
Function: Reduce the damage of oxidative stress to muscles and promote recovery.
Physical factor therapy
Ultrasound: Softens scar tissue and improves local blood circulation.
Laser therapy: Low-intensity laser (600-1000nm) can promote the proliferation of muscle satellite cells and accelerate their repair.
Sixth, handling of special circumstances
Pain management
If the pain is obvious during training, you can take non-steroidal anti-inflammatory drugs (such as ibuprofen) orally or apply cold compresses locally. After the pain is relieved, continue training.
Swelling control
Early postoperative joint swelling may limit muscle contraction. Swelling needs to be reduced by elevating the affected limb, applying compression bandaging or lymphatic drainage techniques.
Nerve injury
If bone plate fixation leads to nerve injury (such as common peroneal nerve injury), nerve electrical stimulation and sensorimotor training should be carried out first, and then muscle strength should be gradually restored.
Seventh, preventive misunderstandings and precautions
Avoid overtraining
After braking, the muscle tolerance decreases. Overtraining may lead to muscle strain or loosening of the internal fixator.
Be vigilant against “disuse osteoporosis”
Long-term immobilization can lead to a decrease in bone density. The weight-bearing should be gradually increased starting from 8 weeks after the operation to stimulate bone formation.
Regular assessment and adjustment
The recovery was evaluated monthly through muscle strength tests (such as manual muscle strength tests) and muscle circumference measurements after the operation, and the training plan was adjusted in a timely manner.