Department of Physical and Rehabilitation Medicine, Dona Estefânia Hospital, Lisbon, Portugal.
Dev Med Child Neurol. 2010 Aug;52(8):754-9. doi: 10.1111/j.1469-8749.2010.03658.x. Epub 2010 Mar 19.
The morbidity associated with osteoporosis and fractures in children and adolescents with spina bifida highlights the importance of osteoporosis prevention and treatment in these patients. The aim of this study was to examine the occurrence and pattern of bone fractures in paediatric patients with spina bifida.
We reviewed the data of all paediatric patients with spina bifida who were treated in our centre between 1999 and 2008.
One hundred and thirteen patients were included in the study (63 females, 50 males; mean age 10y 8mo, SD 4y 10mo, range 6mo-18y). The motor levels were thoracic in six, upper lumbar in 22, lower lumbar in 42, and sacral in 43 patients. Of the 113 patients, 58 (51.3%) had shunted hydrocephalus. Thirty-six (31.8%) were non-ambulatory (wheelchair-dependent [unable to self-propel wheelchair] n=3, wheelchair-independent [able to self-propel wheelchair] n=33), 13 were partial ambulators, 61 were full ambulators, and three were below the age of walking. Forty-five fractures were reported in 25 patients. The distal femur was the most common fracture site. Statistical analyses showed that patients with higher levels of involvement and in wheelchairs had a significantly increased risk of having a [corrected] fracture (p<0.001). Spontaneous fractures were the principal mechanism of injury, and an association was identified between fracture mechanism, type of ambulation, and lesion level: the fractures of patients with higher levels of motor functioning and those in wheelchairs were mainly pathological (p=0.01). We identified an association between risk of a second fracture, higher motor level lesion, and non-ambulation. There was an increased risk of having a second fracture after a previous spontaneous fracture (p=0.004).
Data in this study indicate a high prevalence of fractures in patients with spina bifida.
与骨质疏松症和骨折相关的发病率在患有脊柱裂的儿童和青少年中突出了这些患者中骨质疏松症预防和治疗的重要性。本研究的目的是检查患有脊柱裂的儿科患者中骨折的发生和模式。
我们回顾了 1999 年至 2008 年期间在我们中心治疗的所有患有脊柱裂的儿科患者的数据。
研究纳入 113 例患者（63 例女性，50 例男性；平均年龄 10 岁 8 个月，标准差 4 岁 10 个月，年龄范围 6 个月-18 岁）。运动水平在 6 例为胸段，22 例为上腰椎段，42 例为下腰椎段，43 例为骶骨段。在 113 例患者中，58 例（51.3%）有分流脑积水。36 例（31.8%）为非步行者（无法自行推动轮椅[unable to self-propel wheelchair]n=3，可自行推动轮椅[able to self-propel wheelchair]n=33），13 例为部分步行者，61 例为完全步行者，3 例年龄小于行走年龄。25 例患者报告了 45 例骨折。股骨远端是最常见的骨折部位。统计分析表明，受累程度较高且使用轮椅的患者骨折风险显著增加（p<0.001）。自发性骨折是主要的损伤机制，并且骨折机制、步行类型和病变水平之间存在关联：运动功能较高水平和使用轮椅的患者的骨折主要为病理性的（p=0.01）。我们发现骨折风险、较高的运动功能损伤和非步行之间存在关联。既往自发性骨折后再次发生骨折的风险增加（p=0.004）。
本研究的数据表明脊柱裂患者骨折的患病率较高。
