Parry Joshua, Sullivan Elroy, Scott Allison Cooper
University of Texas Medical School at Houston, Houston, TX, USA.
J Pediatr Orthop. 2011 Apr-May;31(3):331-3. doi: 10.1097/BPO.0b013e3182104a94.
Vitamin D is a critical factor in bone metabolism. Vitamin D levels in both children and adults have been reevaluated to assess standards for sufficiency and deficiency. In the adult population, the currently recommended level for Vitamin D sufficiency is greater than 32 ng/mL measured by 25-hydroxyvitamin D assay. Recommended levels for growing children have not been definitively determined; however, scales based on available literature have been used. The purpose of this study was to evaluate Vitamin D sufficiency in pediatric orthopaedic patients admitted to the hospital for surgical procedures which require bone healing.
Serum 25 hydroxyvitamin D (25 OHD) levels measured by immunochemoluminometric assay were obtained on consecutive pediatric orthopaedic patients admitted electively for long bone osteotomies or spinal fusions over a 10-month period. Seventy patients ranging in age from 2 to 19 years were screened for Vitamin D sufficiency. Vitamin D levels were examined for correlation with age, sex, ethnicity, body mass index (BMI), BMI percentile, orthopaedic diagnosis, and season.
Total 90% of the screened patients had 25 OH vitamin D levels below 32 ng/mL. African American children were more likely to have severe Vitamin D deficiency (P=0.013). Vitamin D levels were lower in the winter months (P=0.046). When 20 ng/mL was used as a cutoff, the average age of children below this cutoff was higher than those above (P=0.018). There was no correlation of Vitamin D levels with sex, BMI, BMI percentile, residence in Mexico, and diagnosis.
Total 90% of the children in the screening group were at risk for poor bone healing owing to Vitamin D deficiency or insufficiency. African American children, in particular, should be evaluated for Vitamin D sufficiency before orthopaedic surgeries. Further work must be done to determine the impact of Vitamin D insufficiency on surgical outcomes.
Diagnostic study, III.
维生素D是骨代谢的关键因素。儿童和成人的维生素D水平都已重新评估，以确定充足和缺乏的标准。在成年人群中，目前推荐的维生素D充足水平是通过25-羟基维生素D检测法测得大于32 ng/mL。对于正在成长的儿童，推荐水平尚未明确确定；然而，已使用基于现有文献的标准。本研究的目的是评估因需要骨愈合的外科手术而入院的儿科骨科患者的维生素D充足情况。
在10个月期间，对连续择期接受长骨截骨术或脊柱融合术的儿科骨科患者，通过免疫化学发光法测定血清25-羟基维生素D（25-OHD）水平。对70名年龄在2至19岁的患者进行维生素D充足情况筛查。检查维生素D水平与年龄、性别、种族、体重指数（BMI）、BMI百分位数、骨科诊断和季节的相关性。
总共90%的筛查患者25-OH维生素D水平低于32 ng/mL。非裔美国儿童更有可能患有严重维生素D缺乏（P = 0.013）。冬季维生素D水平较低（P = 0.046）。当以20 ng/mL作为临界值时，低于此临界值的儿童平均年龄高于高于此临界值的儿童（P = 0.018）。维生素D水平与性别、BMI、BMI百分位数、在墨西哥居住情况和诊断无关。
筛查组中总共90%的儿童因维生素D缺乏或不足而有骨愈合不良的风险。特别是非裔美国儿童，在骨科手术前应评估维生素D充足情况。必须进一步开展工作以确定维生素D不足对手术结果的影响。
诊断性研究，III级
