BAppSc, PT, Monash Medical Centre, Victorian Paediatric Rehabilitation Service, 246 Clayton Rd, Clayton, Victoria 3168, Australia.
Pediatrics. 2010 Mar;125(3):e670-8. doi: 10.1542/peds.2009-0292. Epub 2010 Feb 1.
To systematically review the efficacy of interventions to improve low bone mineral density (LBMD) in children and adolescents with cerebral palsy (CP).
We performed a systematic search for published randomized, controlled trials (RCTs) and controlled clinical trials (CCTs) of children with CP (aged 0-20 years, all Gross Motor Function Classification System [GMFCS] levels) who received various medical and physical interventions for LBMD compared with no intervention or standard care. Study validity was evaluated by using the Physiotherapy Evidence Database (PEDro) scale. Standardized mean differences (SMDs) were calculated when data were sufficient.
Eight of 2034 articles met the inclusion criteria (6 RCTs, 2 CCTs). There were 3 trials of bisphosphonates, one of which (Henderson RC, Lark RK, Kecskemethy HH, Miller F, Harcke HT, Bachrach SJ. J Pediatr. 2002;141[5]:644-651) revealed a large and significant effect on BMD in 1 of 3 sites in the distal femur (SMD: 1.88 [95% confidence interval (CI): 0.52-3.24]). There were 3 trials of weight-bearing through varying approaches, one of which (Caulton JM, Ward KA, Alsop CW, Dunn G, Adams JE, Mughal MZ. Arch Dis Child. 2004;89[2]:131-135) showed a large and significant effect on the lumbar spine when increasing static standing time (SMD: 1.03 [95% CI: 0.21-1.85]). The administration of vitamin D and calcium produced a large, nonsignificant effect on BMD in the lumbar spine (Jekovec-Vrhovsek M, Kocijancic A, Prezelj J. Dev Med Child Neurol. 2000;42[6]:403-405) (SMD: 0.88 [95% CI: -0.07 to 1.84). Growth hormone combined with vitamin D and/or calcium resulted in effects comparable with vitamin D and/or calcium on BMD in the lumbar spine (Ali O, Shim M, Fowler E, et al. J Clin Endocrinol Metab. 2007;92[3]:932-937) (SMD 0 [95% CI: -1.24 to 1.24]).
Important effects on LBMD have been observed in small and diverse cohorts of children with CP. It is unclear whether small sample sizes or variable treatment responses account for nonsignificant findings. Additional large RCTs are needed of both physical and medical approaches.
系统评价改善脑瘫（CP）儿童低骨密度（LBMD）的干预措施的疗效。
我们对已发表的随机对照试验（RCT）和对照临床试验（CCT）进行了系统检索，纳入了接受各种医疗和物理干预措施以改善 LBMD 的 CP 儿童（年龄 0-20 岁，所有粗大运动功能分类系统 [GMFCS] 分级），并与未干预或标准护理进行比较。使用物理治疗证据数据库（PEDro）量表评估研究有效性。当数据充足时，计算标准化均数差（SMD）。
2034 篇文章中有 8 篇符合纳入标准（6 项 RCT，2 项 CCT）。有 3 项双膦酸盐的试验，其中 1 项（Henderson RC、Lark RK、Kecskemethy HH、Miller F、Harcke HT、Bachrach SJ。J Pediatr. 2002;141[5]:644-651）显示在股骨远端 3 个部位中的 1 个部位的骨密度有较大且显著的影响（SMD：1.88 [95%置信区间（CI）：0.52-3.24]）。有 3 项负重试验，其中 1 项（Caulton JM、Ward KA、Alsop CW、Dunn G、Adams JE、Mughal MZ。Arch Dis Child. 2004;89[2]:131-135）显示增加静态站立时间对腰椎骨密度有较大且显著的影响（SMD：1.03 [95% CI：0.21-1.85]）。维生素 D 和钙的补充对腰椎骨密度有较大但无统计学意义的影响（Jekovec-Vrhovsek M、Kocijancic A、Prezelj J。Dev Med Child Neurol. 2000;42[6]:403-405）（SMD：0.88 [95% CI：-0.07 至 1.84）。生长激素联合维生素 D 和/或钙的治疗效果与维生素 D 和/或钙对腰椎骨密度的效果相当（Ali O、Shim M、Fowler E 等。J Clin Endocrinol Metab. 2007;92[3]:932-937）（SMD 0 [95% CI：-1.24 至 1.24]）。
在 CP 儿童的小样本和不同队列中观察到对 LBMD 的重要影响。尚不清楚小样本量还是治疗反应的差异导致了无统计学意义的结果。需要进一步开展关于物理和医疗方法的大型 RCT。
