Department of Radiology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Skeletal Radiol. 2020 Jan;49(1):85-91. doi: 10.1007/s00256-019-03261-6. Epub 2019 Jun 26.
To examine the association between rachitic changes and vitamin D levels in children less than 2 years old with fractures.
Children less than 2 years old who were admitted to a large children's hospital for a fracture and underwent a skeletal survey were included. Two pediatric radiologists blinded to the children's vitamin D levels independently reviewed the skeletal surveys for the following rachitic findings: demineralization, widened sutures, rachitic rosary, Looser zones, and metaphyseal changes. Kappa coefficients were calculated to assess inter-rater agreement. Logistic regression was used to test the association between vitamin D level and rachitic findings.
There were 79 subjects (40 female and 39 male) with a median age of 4 months. Vitamin D levels ranged from 11.6 to 88.9 ng/ml and were low in 27. Questionable demineralization was noted in seven subjects; mild to moderate demineralization was observed in four subjects. Widened sutures were noted in seven subjects, many also with concurrent intracranial hemorrhage. Lower vitamin D levels were associated with increased odds of demineralization after adjusting for age, gender, and prematurity (P < 0.015). An association was not found between the vitamin D level and suture widening (P = 0.07). None of the cases demonstrated Looser zones, rachitic rosary, or metaphyseal changes of rickets.
Infants and toddlers with fractures frequently have suboptimal vitamin D levels, but radiographic evidence of rickets is uncommon in these children.
探讨 2 岁以下骨折患儿佝偻病改变与维生素 D 水平的关系。
纳入因骨折在一家大型儿童医院就诊并接受骨骼检查的 2 岁以下儿童。两名儿科放射科医生在不知道儿童维生素 D 水平的情况下，独立对骨骼检查结果进行评估，以确定佝偻病的以下表现：脱矿质、骨缝增宽、佝偻病串珠、干骺端疏松带和干骺端变化。计算 Kappa 系数评估组内一致性。采用 logistic 回归检验维生素 D 水平与佝偻病表现之间的关系。
共纳入 79 例（女 40 例，男 39 例），中位年龄为 4 个月。维生素 D 水平范围为 11.6 至 88.9ng/ml，27 例为低水平。7 例存在可疑脱矿质，4 例存在轻至中度脱矿质。7 例存在骨缝增宽，许多患儿同时伴有颅内出血。校正年龄、性别和早产因素后，维生素 D 水平降低与脱矿质的可能性增加相关（P<0.015）。维生素 D 水平与骨缝增宽之间未见关联（P=0.07）。未发现 Looser 区、佝偻病串珠或佝偻病干骺端变化。
骨折婴儿和幼儿维生素 D 水平往往不理想，但这些儿童的骨骼检查很少有佝偻病的放射学证据。
