Sharawat Indar Kumar, Sitaraman Sadasivan
Senior Resident, Department of Pediatric Medicine, VMMC and Safdarjung Hospital , New Delhi, India .
Professor and Head of Department, Department of Pediatric Medicine, SMS Medical College , Jaipur, Rajasthan, India .
J Clin Diagn Res. 2016 Jun;10(6):SC01-5. doi: 10.7860/JCDR/2016/18620.7921. Epub 2016 Jun 1.
Diminished bone mineral density and delayed skeletal maturation are common in children with spastic quadriplegia.
The purpose of our study was to evaluate the Bone Mineral Density (BMD) of children with moderate to severe spastic quadriplegia and its relationship with other variables like nutrition and growth.
This was a hospital based, cross- sectional, case-control study. Forty-two (28 males, 14 females) children with spastic quadriplegia and 42 (24 males, 18 females) healthy children were included in the study. BMD of cases and control were measured by Dual Energy X-ray Absorptiometry (DEXA). Radiographs of left hand and wrist of cases and controls were taken and bone age was determined.
BMD values of upper extremity, lower extremity, thoraco-lumbar spine and pelvis in cases were lower than those of controls (p <0.0001). In children with non severe malnutrition, 75% of the cases had lower bone age than chronological age, whereas all cases with severe malnutrition had lower bone age than chronological age. Step wise regression analysis showed that nutritional status independently contributed to lower BMD values but the BMD values did not correlate significantly with the use of anticonvulsant drugs and presence of physical therapy.
Decreased BMD and delayed bone age is prevalent in children with spastic quadriplegia and nutritional status is an important contributing factor.
骨矿物质密度降低和骨骼成熟延迟在痉挛性四肢瘫痪儿童中很常见。
我们研究的目的是评估中重度痉挛性四肢瘫痪儿童的骨矿物质密度（BMD）及其与营养和生长等其他变量的关系。
这是一项基于医院的横断面病例对照研究。42名（28名男性，14名女性）痉挛性四肢瘫痪儿童和42名（24名男性，18名女性）健康儿童被纳入研究。通过双能X线吸收法（DEXA）测量病例组和对照组的骨密度。拍摄病例组和对照组左手和手腕的X线片并确定骨龄。
病例组上肢、下肢、胸腰椎和骨盆的骨密度值低于对照组（p<0.0001）。在非严重营养不良的儿童中，75%的病例骨龄低于实际年龄，而所有严重营养不良的病例骨龄均低于实际年龄。逐步回归分析表明，营养状况独立导致较低的骨密度值，但骨密度值与抗惊厥药物的使用和物理治疗的存在无显著相关性。
痉挛性四肢瘫痪儿童中骨密度降低和骨龄延迟很普遍，营养状况是一个重要的促成因素。
