Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Disabil Rehabil. 2021 May;43(9):1287-1291. doi: 10.1080/09638288.2019.1660915. Epub 2019 Sep 4.
To determine prevalence, incidence and risk factors for foot pressure ulcers in ambulatory children with spina bifida.
Retrospective cohort study of 72 ambulatory children (age range 0-23.9 years) with spina bifida treated at a pediatric tertiary care facility. Data on foot pressure ulcers were recorded and analyzed to determine prevalence, incidence and predictive factors.
Foot pressure ulcers occurred in 50/143 limbs (35%) over 10.5 ± 3.5 years. Average incidence was 0.10 foot pressure ulcer incidents per person-year, and prevalence in years with complete follow-up was 8.8%. Prevalence was related to age [higher for ages 11-15 (17%), than ages 0-10 (5%) and 16+ years (7%), < 0.0001], and varus/valgus foot deformities ( < 0.001) and brace use (0.32 risk difference, = 0.01), but not with standing foot position, deformity rigidity, body mass index, spina bifida type, lesion level, ambulatory level or co-morbidities. Most common sites were the heel (21/96, 22%), lateral malleolus (12/96, 13%), and plantar 5 metatarsal head (11/96, 12%).
Foot pressure ulcers occur in nearly 1 out of 10 ambulatory children with spina bifida, most often in pre-teens or young teen-agers with foot deformities, who use braces. This information can help direct skin care education and prevention to those most vulnerable.Implications for RehabilitationFoot pressure ulcers occur in children and adolescents with spina bifida, most commonly in those aged 11-15 years, with foot deformities and who use braces.Ulcer development was unrelated to stiffness of foot deformity, body mass index, lesion or functional level, or presence of comorbidities such as Arnold-Chiari malformation, syringomyelia or shunted hydrocephalus.Skin care education and preventative measures should be provided to all patients, but with particular emphasis for those with these risk factors.
确定在门诊脊髓脊膜膨出患儿中足压疮的患病率、发病率和危险因素。
回顾性队列研究纳入在儿科三级医疗机构接受治疗的 72 名门诊脊髓脊膜膨出患儿（年龄 0-23.9 岁）。记录并分析足部压疮数据，以确定患病率、发病率和预测因素。
143 条肢体中有 50 条（35%）发生足部压疮，随访时间为 10.5±3.5 年。平均发病率为 0.10 例足部压疮/人年，在完整随访年的患病率为 8.8%。患病率与年龄有关[11-15 岁（17%）高于 0-10 岁（5%）和 16 岁以上（7%）， < 0.0001]，与足内翻/外翻畸形（ < 0.001）和支具使用（0.32 风险差异， = 0.01）有关，但与站立时足部位置、畸形僵硬度、体重指数、脊髓脊膜膨出类型、病变水平、步行能力水平或合并症无关。最常见的部位是足跟（21/96，22%）、外踝（12/96，13%）和足底第 5 跖骨头（11/96，12%）。
近 10%的门诊脊髓脊膜膨出患儿发生足部压疮，最常发生在青少年足畸形和使用支具的患儿。这些信息可以帮助针对最脆弱的人群进行皮肤护理教育和预防。
脊髓脊膜膨出患儿，尤其是青少年、足部畸形和使用支具的患儿，足部压疮较为常见。溃疡的发展与足部畸形的僵硬程度、体重指数、病变或功能水平无关，也与Arnold-Chiari 畸形、脊髓空洞症或分流性脑积水等合并症无关。应向所有患者提供皮肤护理教育和预防措施，但对存在这些危险因素的患者应特别强调。
