Henderson Richard C, Lark Robert K, Gurka Matthew J, Worley Gordon, Fung Ellen B, Conaway Mark, Stallings Virginia A, Stevenson Richard D
Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
Pediatrics. 2002 Jul;110(1 Pt 1):e5. doi: 10.1542/peds.110.1.e5.
Diminished bone density and a propensity to fracture with minimal trauma are common in children and adolescents with moderate to severe cerebral palsy (CP). The purpose of this study was to provide a detailed evaluation of bone mineral density (BMD) and metabolism in this population and to assess the relationship of these measures to multiple other clinical, growth, and nutrition variables.
The study group consisted of 117 subjects ages 2 to 19 years (mean: 9.7 years) with moderate to severe CP as defined by the Gross Motor Functional Classification scale. Population-based sampling was used to recruit 62 of the participants, which allows for estimations of prevalence. The remaining 55 subjects were a convenience sampling from both hospital- and school-based sources. The evaluation included measures of BMD, a detailed anthropometric assessment of growth and nutritional status, medical and surgical history, the Child Health Status Questionnaire, and multiple serum analyses. BMD was measured in the distal femur, a site specifically developed for use in this contracted population, and the lumbar spine. BMD measures were converted to age and gender normalized z scores based on our own previously published control series (n > 250).
Osteopenia (BMD z score <-2.0) was found in the femur of 77% of the population-based cohort and in 97% of all study participants who were unable to stand and were older than 9 years. BMD was not as low in the lumbar spine (population-based cohort mean +/- standard error z score: -1.8 +/- 0.1) as in the distal femur (mean z score: -3.1 +/- 0.2). Fractures had occurred in 26% of the children who were older than 10 years. Multiple clinical and nutritional variables correlated with BMD z scores, but interpretation of these findings is complicated by covariance among variables. In stepwise regression analyses, it was found that severity of neurologic impairment as graded by Gross Motor Functional Classification level, increasing difficulty feeding the child, use of anticonvulsants, and lower triceps skinfold z scores (in decreasing order of importance) all independently contribute to lower BMD z scores in the femur.
Low BMD is prevalent in children with moderate to severe CP and is associated with significant fracture risk. The underlying pathophysiology is complex, with multiple factors contributing to the problem and significant variation between different regions of the skeleton.
在中度至重度脑瘫（CP）患儿和青少年中，骨密度降低以及轻微创伤即可导致骨折的倾向较为常见。本研究旨在详细评估该人群的骨矿物质密度（BMD）和代谢情况，并评估这些指标与其他多种临床、生长和营养变量之间的关系。
研究组由117名年龄在2至19岁（平均9.7岁）的中度至重度CP患者组成，其严重程度由粗大运动功能分类量表定义。采用基于人群的抽样方法招募了62名参与者，以便对患病率进行估计。其余55名受试者是从医院和学校来源进行的便利抽样。评估内容包括BMD测量、对生长和营养状况的详细人体测量评估、病史和手术史、儿童健康状况问卷以及多项血清分析。BMD在股骨远端（专门为该特定人群开发的部位）和腰椎进行测量。根据我们之前发表的对照系列（n>250），将BMD测量值转换为年龄和性别标准化z分数。
在基于人群的队列中，77%的患者股骨出现骨质减少（BMD z分数<-2.0），在所有无法站立且年龄大于9岁的研究参与者中，这一比例为97%。腰椎的BMD不像股骨远端那么低（基于人群的队列平均±标准误z分数：-1.8±0.1）（平均z分数：-3.1±0.2）。10岁以上儿童中有26%发生过骨折。多个临床和营养变量与BMD z分数相关，但由于变量之间的协方差，对这些结果的解释较为复杂。在逐步回归分析中发现，按粗大运动功能分类水平分级的神经功能损害严重程度、喂养孩子难度增加、使用抗惊厥药物以及较低的三头肌皮褶z分数（按重要性降序排列）均独立导致股骨BMD z分数降低。
中度至重度CP患儿中低BMD普遍存在，并与显著的骨折风险相关。潜在的病理生理机制复杂，多种因素导致该问题，且骨骼不同区域之间存在显著差异。
