OBJECTIVE To evaluate whether tobacco use, alcohol consumption, and weight gain are associated with the diagnosis of overuse musculoskeletal injuries within the first 12 months following lower limb amputation. DESIGN Retrospective cohort study. SETTING Military treatment facilities. PARTICIPANTS A total of 681 Service members with a deployment-related lower limb amputation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Clinical diagnosis codes associated with musculoskeletal overuse injuries of the lower limb, upper limb, and low back regions. RESULTS In the first three months after amputation, tobacco use and alcohol consumption were reported in 55.7% and 72.0% of the retrospective sample and the overall mean weight change was 22.9 ± 23.6 pounds. The prevalence of reporting at least one overuse injury within 4 to 12 months after amputation was 57.0% in the sample, with prevalence rates of lower limb, upper limb and low back pain diagnoses at 28.3%, 21.7%, and 21.1%, respectively. Service members reporting tobacco use in the first three months after amputation were nearly twice as likely to be diagnosed with a lower limb musculoskeletal injury in months 4 to 12 after amputation. Similarly, Service members reporting alcohol consumption within the first three months after amputation were more than twice as likely to be diagnosed with at least one overuse musculoskeletal injury in months 4 to 12 after amputation. However, weight change or maximum weight after amputation were not associated with the diagnosis of an overuse musculoskeletal injury. CONCLUSIONS Development of secondary overuse musculoskeletal injury appears to be related to tobacco use and alcohol consumption, but not weight gain. These findings warrant focused research efforts towards developing preventive interventions.

中文翻译：

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烟草使用、饮酒和体重增加对下肢截肢后继发性肌肉骨骼损伤发展的影响

目的 评估烟草使用、饮酒和体重增加是否与下肢截肢后前 12 个月内过度使用肌肉骨骼损伤的诊断相关。设计 回顾性队列研究。设置军事治疗设施。参与者 共有 681 名服役人员因部署相关下肢截肢。干预 不适用。主要观察指标与下肢、上肢和腰部肌肉骨骼过度使用损伤相关的临床诊断代码。结果 在截肢后的前三个月，55.7% 和 72.0% 的回顾性样本报告了吸烟和饮酒，总体平均体重变化为 22.9 ± 23.6 磅。样本中截肢后 4 至 12 个月内报告至少一次过度使用损伤的患病率为 57.0%，下肢、上肢和腰痛诊断的患病率分别为 28.3%、21.7% 和 21.1%。报告在截肢后前三个月使用烟草的服务人员在截肢后 4 到 12 个月内被诊断出下肢肌肉骨骼损伤的可能性几乎是其两倍。同样，报告截肢后前三个月内饮酒的服务人员在截肢后 4 至 12 个月内被诊断出至少一次过度使用肌肉骨骼损伤的可能性是其两倍以上。然而，截肢后的体重变化或最大体重与过度使用肌肉骨骼损伤的诊断无关。结论继发性过度使用肌肉骨骼损伤的发生似乎与吸烟和饮酒有关，但与体重增加无关。这些发现保证了针对开发预防干预措施的重点研究工作。