高频低强度振动对脑瘫患儿骨骼和肌肉的影响。
Effect of high-frequency, low-magnitude vibration on bone and muscle in children with cerebral palsy.
作者信息
Wren Tishya A L, Lee David C, Hara Reiko, Rethlefsen Susan A, Kay Robert M, Dorey Frederick J, Gilsanz Vicente
机构信息
Childrens Orthopaedic Center, Childrens Hospital, Los Angeles, Los Angeles, CA 90027, USA.
出版信息
J Pediatr Orthop. 2010 Oct-Nov;30(7):732-8. doi: 10.1097/BPO.0b013e3181efbabc.
BACKGROUND
Children with cerebral palsy (CP) have decreased strength, low bone mass, and an increased propensity to fracture. High-frequency, low-magnitude vibration might provide a noninvasive, nonpharmacologic, home-based treatment for these musculoskeletal deficits. The purpose of this study was to examine the effects of this intervention on bone and muscle in children with CP.
METHODS
Thirty-one children with CP ages 6 to 12 years (mean 9.4, SD 1.4) stood on a vibrating platform (30 Hz, 0.3 g peak acceleration) at home for 10 min/d for 6 months and on the floor without the platform for another 6 months. The order of vibration and standing was randomized, and outcomes were measured at 0, 6, and 12 months. The outcome measures included computed tomography measurements of vertebral cancellous bone density (CBD) and cross-sectional area, CBD of the proximal tibia, geometric properties of the tibial diaphysis, and dynamometer measurements of plantarflexor strength. They were assessed using mixed model linear regression and Pearson correlation.
RESULTS
The main difference between vibration and standing was that there was a greater increase in the cortical bone properties (cortical bone area and moments of inertia) during the vibration period (all P's ≤ 0.03). There was no difference in cancellous bone or muscle between vibration and standing (all P's > 0.10) and no correlation between compliance and outcome (all r's < 0.27; all P's > 0.15). The results did not depend on the order of treatment (P > 0.43) and were similar for children in gross motor function classification system (GMFCS) 1 to 2 and GMFCS 3 to 4.
CONCLUSIONS
The primary benefit of the vibration intervention in children with CP was to the cortical bone in the appendicular skeleton. Increased cortical bone area and the structural (strength) properties could translate into a decreased risk of long bone fractures in some patients. More research is needed to corroborate these findings, to elucidate the mechanisms of the intervention, and to determine the most effective age and duration of the treatment.
LEVEL OF EVIDENCE
Level II, prospective randomized cross-over study.
背景
脑瘫（CP）患儿肌力下降、骨量低且骨折倾向增加。高频、低强度振动可能为这些肌肉骨骼缺陷提供一种无创、非药物的居家治疗方法。本研究的目的是探讨这种干预措施对CP患儿骨骼和肌肉的影响。
方法
31名6至12岁（平均9.4岁，标准差1.4）的CP患儿在家中站在振动平台上（30Hz，峰值加速度0.3g），每天10分钟，持续6个月，然后在无平台的地面站立6个月。振动和站立的顺序是随机的，在0、6和12个月时测量结果。结果测量包括椎体松质骨密度（CBD）和横截面积的计算机断层扫描测量、胫骨近端的CBD、胫骨干的几何特性以及足底屈肌力量的测力计测量。使用混合模型线性回归和Pearson相关性进行评估。
结果
振动和站立之间的主要差异在于，在振动期间皮质骨特性（皮质骨面积和惯性矩）有更大的增加（所有P值≤0.03）。振动和站立之间的松质骨或肌肉没有差异（所有P值>0.10），依从性和结果之间也没有相关性（所有r值<0.27；所有P值>0.15）。结果不取决于治疗顺序（P>0.43），对于粗大运动功能分类系统（GMFCS）1至2级和GMFCS 3至4级的儿童结果相似。
结论
振动干预对CP患儿的主要益处在于四肢骨骼的皮质骨。皮质骨面积增加和结构（强度）特性改善可能会降低部分患者长骨骨折的风险。需要更多研究来证实这些发现，阐明干预机制，并确定最有效的治疗年龄和疗程。
证据水平
二级，前瞻性随机交叉研究。
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