Dosa Nienke P, Eckrich Michael, Katz Danielle A, Turk Margaret, Liptak Gregory S
SUNY Upstate Medical Center, Syracuse, New York, USA.
J Spinal Cord Med. 2007;30 Suppl 1(Suppl 1):S5-9. doi: 10.1080/10790268.2007.11753961.
To determine the age-specific incidence, prevalence, and characteristics of fractures in persons with spina bifida.
Year-long historical cross-sectional study.
Two hundred twenty-one consecutive patients aged 2-58 years evaluated in 2003 at a regional referral center. Twenty percent (n=44) were children age 2-10 years; 30% (n=68) were adolescents age 11-18 years; and 50% (n=109) were adults age 19-58 years. Fifty-five percent (n=121) were female; 64% (n=141) had shunted hydrocephalus. Fifty-eight percent (n=129) were community ambulators. Defect levels included 14% (n=31) thoracic; 37% (n=81) mid-lumbar; 35% (n=79) low-lumbar; and 14% (n = 30) sacral.
Chart review of 221 consecutive children, adolescents, and adults enrolled in a spina bifida program in Syracuse, New York, was used to determine incidence and prevalence rates. Chi-square was used for subgroup analyses, and linear regression was used to examine independent association of motor level, functional independence (Functional Independence Measures score), body mass index (BMI), shunted hydrocephalus, epilepsy, and/or other congenital anomalies with fractures, controlling for insurance status, race/ethnicity, age, and sex.
Annual incidence of fractures among children, adolescents, and adults was 23/1000; 29/1000; and 18/1000, respectively. Overall prevalence was 200/1000. One in 4 patients with fractures reported multiple fractures. Median age at first fracture was 11 years. Most fractures involved the femur or tibia. Comparisons between adult- and childhood-onset fractures were not significant for difference in sex, BMI, defect level, functional independence, shunted hydrocephalus, epilepsy, or other congenital anomalies. In regression models only defect level RR = 1.646 (P = 0.019; 95% CI 1.085-2.498) and age RR = 1.033 (P= 0.036; 95% CI 1.002-1.065) were independently associated with fractures.
Fractures in persons with spina bifida are most common during early adolescence. Environmental modifications may be more effective than pharmacological treatment in reducing the prevalence of fractures in this population.
确定脊柱裂患者骨折的年龄特异性发病率、患病率及特征。
为期一年的历史性横断面研究。
2003年在一家地区转诊中心接受评估的221例年龄在2至58岁的连续患者。20%（n = 44）为2至10岁的儿童；30%（n = 68）为11至18岁的青少年；50%（n = 109）为19至58岁的成年人。55%（n = 121）为女性；64%（n = 141）患有分流性脑积水。58%（n = 129）为社区行走者。缺陷水平包括14%（n = 31）胸椎；37%（n = 81）中腰椎；35%（n = 79）低腰椎；14%（n = 30）骶骨。
对纽约锡拉丘兹脊柱裂项目中连续纳入的221例儿童、青少年和成年人进行病历审查，以确定发病率和患病率。采用卡方检验进行亚组分析，采用线性回归分析运动水平、功能独立性（功能独立性测量评分）、体重指数（BMI）、分流性脑积水、癫痫和/或其他先天性异常与骨折的独立关联，并对保险状况、种族/民族、年龄和性别进行控制。
儿童、青少年和成年人骨折的年发病率分别为23/1000；29/1000；和18/1000。总体患病率为200/1000。每4例骨折患者中有1例报告有多处骨折。首次骨折的中位年龄为11岁。大多数骨折累及股骨或胫骨。成人骨折和儿童期骨折在性别、BMI、缺陷水平、功能独立性、分流性脑积水、癫痫或其他先天性异常方面的差异无统计学意义。在回归模型中，只有缺陷水平RR = 1.646（P = 0.019；95%CI 1.085 - 2.498）和年龄RR = 1.033（P = 0.036；95%CI 1.002 - 1.065）与骨折独立相关。
脊柱裂患者骨折在青春期早期最为常见。在降低该人群骨折患病率方面，环境改造可能比药物治疗更有效。
