Mergler Sandra, Evenhuis Heleen M, Boot Annemieke M, De Man Stella A, Bindels-De Heus Karen G C B, Huijbers Wim A R, Penning Corine
Medical Department ASVZ, Care and Service Centre for People with Intellectual Disabilities, Sliedrecht, the Netherlands.
Dev Med Child Neurol. 2009 Oct;51(10):773-8. doi: 10.1111/j.1469-8749.2009.03384.x. Epub 2009 Jul 8.
Children with severe cerebral palsy (CP) are at risk for developing low bone mineral density (BMD) and low-impact fractures. The aim of this study was to provide a systematic literature review of the epidemiology of fractures and low BMD in children with severe CP, with an emphasis on risk factors. Gross Motor Function Classification System (GMFCS) levels IV and V were criteria for severe cerebral palsy.
The literature (PubMed) was searched and eligible studies were given a level of evidence score using the Scottish Intercollegiate Guidelines Network criteria.
Seven studies were found concerning epidemiology of fractures, 11 studies described epidemiology of low BMD, and 14 studies concerned risk factors. The methodological quality of most of these studies was poor. Five studies were considered well-conducted with low risk of confounding and bias. In these studies, the incidence of fractures in children with moderate to severe CP approached 4% per year, whereas the prevalence of low BMD in the femur was 77%. Limited ambulation, feeding difficulties, previous fractures, anticonvulsant use, and lower body fat mass were associated with low BMD z-scores.
There is only a limited amount of high-quality evidence on low BMD and fractures in children with severe CP.
重度脑瘫（CP）患儿有发生低骨矿物质密度（BMD）和低冲击性骨折的风险。本研究旨在对重度CP患儿骨折和低BMD的流行病学进行系统的文献综述，重点关注危险因素。粗大运动功能分类系统（GMFCS）IV级和V级为重度脑瘫的标准。
检索文献（PubMed），并根据苏格兰校际指南网络标准对符合条件的研究给予证据水平评分。
发现7项关于骨折流行病学的研究，11项描述了低BMD的流行病学，14项研究涉及危险因素。这些研究大多方法学质量较差。5项研究被认为实施良好，混杂和偏倚风险低。在这些研究中，中重度CP患儿的骨折发生率接近每年4%，而股骨低BMD的患病率为77%。活动受限、喂养困难、既往骨折、使用抗惊厥药物以及较低的体脂量与低BMD z评分相关。
关于重度CP患儿低BMD和骨折的高质量证据有限。
