儿童前臂骨折后桡骨远端的快速再矿化

Rapid remineralization of the distal radius after forearm fracture in children.

作者信息

Fung Ellen B, Humphrey Marcie L, Gildengorin Ginny, Goldstein Natalie, Hoffinger Scott A

机构信息

Children’s Hospital & Research Center, Oakland, HEDCO Health Science Center 5700 Martin Luther King Jr Way, Oakland, CA 94609, USA.

出版信息

J Pediatr Orthop. 2011 Mar;31(2):138-43. doi: 10.1097/BPO.0b013e3182093ddd.

DOI:10.1097/BPO.0b013e3182093ddd

PMID:21307706

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3079274/

Abstract

BACKGROUND

Bone mineral content (BMC) and density (BMD) have been shown to diminish after fracture and immobilization in adults. Distal radius fractures are common in children, and unlike adults, there is a low incidence of refracture. The primary aim of this study was to assess the change in radial BMC and BMD after upper extremity fracture and casting in healthy pediatric patients.

METHODS

Patients were recruited at the time of distal radius fractures casting. The nonfractured (non-Fx) distal radius was initially scanned by dual energy x-ray absorptiometry (baseline), and then both arms were scanned at the time of cast removal (CastOff), and 4, 8, 12, 24, and 52 weeks post CastOff.

RESULTS

Twenty-one patients were enrolled (13 male, 13 Caucasian; 10.4±2.5 y) with an average length of casting of 38±11 days. Eighteen patients (86%) completed all protocol requirements. At CastOff, there was no significant difference in total BMC or BMD between the Fx and non-Fx arms. From CastOff to 24 weeks, the overall change in BMC and BMD for the non-Fx arm was +4.2% and +0.2%, respectively, whereas for the Fx arm, the change was +8.3% and +3.4%, respectively. By 24 weeks, the difference in the overall change in BMD between the Fx and non-Fx arms was statistically significant (greater than instrumental error; P<0.05). However, by 52 weeks, these differences were no longer significant. The increased mineralization was unrelated to age, sex, arm dominance, or calcium intake.

CONCLUSIONS

These data show that there is rapid remineralization after a simple forearm fracture in children, with a transient elevation in BMD in the Fx arm after casting. This novel finding suggests that bone may be stronger around the site of fracture and could significantly change how we counsel young patients recovering from forearm fracture. Future research should focus on children immobilized for varying lengths of time and those with repeat fractures, using volumetric techniques of bone geometry and strength assessment.

CASE SERIES

Therapeutic Studies-investigating the results of treatment, Level IV.

摘要

背景

已有研究表明，成人骨折和固定后骨矿物质含量（BMC）和骨密度（BMD）会降低。桡骨远端骨折在儿童中很常见，与成人不同的是，再次骨折的发生率较低。本研究的主要目的是评估健康小儿患者上肢骨折及石膏固定后桡骨BMC和BMD的变化。

方法

在桡骨远端骨折石膏固定时招募患者。首先通过双能X线吸收法对未骨折（非Fx）的桡骨远端进行扫描（基线），然后在拆除石膏时（CastOff）以及拆除石膏后4周、8周、12周、24周和52周对双臂进行扫描。

结果

共纳入21例患者（13例男性，13例白种人；年龄10.4±2.5岁），平均石膏固定时间为38±11天。18例患者（86%）完成了所有方案要求。在CastOff时，Fx臂和非Fx臂的总BMC或BMD无显著差异。从CastOff到24周，非Fx臂的BMC和BMD总体变化分别为+4.2%和+0.2%，而Fx臂的变化分别为+8.3%和+3.4%。到24周时，Fx臂和非Fx臂的BMD总体变化差异具有统计学意义（大于仪器误差；P<0.05）。然而，到52周时，这些差异不再显著。矿化增加与年龄、性别、优势臂或钙摄入量无关。