From the Department of Physical Therapy and Rehabilitation, Hacettepe University,Faculty of Health Sciences, Ankara, Turkey (S. Yildiz); Department of Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (AMG, JF); Department of Occupational Physical Therapy, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (TE); Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (JFB, GT, BLB, S. Yum); and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania (JFB, GT, BLB, S. Yum).
Am J Phys Med Rehabil. 2020 Sep;99(9):789-794. doi: 10.1097/PHM.0000000000001423.
Prevalence and characteristics of fractures and factors related to loss of ambulation after lower limb fractures were investigated.
Chart review included height, weight, dual-energy x-ray absorptiometry, corticosteroid use, vitamin D, fracture history, muscle strength, range of motion, and timed performance tests (10 meter walk/run, Gowers, and four steps). Patients were grouped by fracture location and ambulation loss after fracture.
Two hundred eighty-seven patients with Duchenne muscular dystrophy were identified, 53 of these had experienced fracture. Eighty-one percent were older than 9 yrs at first fracture and 36.4% became nonambulatory after fracture. Dorsiflexion range of motion (fracture side, P = 0.021), quadriceps strength (right side, P = 0.025), and shoulder abduction strength (right, left, and fracture side; P = 0.028, P = 0.027, and P = 0.016) were significantly different within the groups. Patients who became nonambulatory after fracture initially had less dorsiflexion (right, left, fracture side; 2.25 vs. -7.29, P = 0.004; 2.67 vs. -12, P = 0.001; and 2.41 vs. -7.42, P = 0.002) and slower 10-meter walk/run times (7.43 secs vs. 14.7 secs, P = 0.005).
Fracture represents a significant risk in patients with Duchenne muscular dystrophy; both slower walking speed and ankle contracture confer an increased risk of ambulation loss after fracture.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Identify the main factors that are associated with ambulation loss after fracture in patients with Duchenne muscular dystrophy; (2) Identify the risk of fracture in the Duchenne muscular dystrophy population; and (3) Articulate the characteristics associated with fracture in patients with Duchenne muscular dystrophy.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
调查下肢骨折后骨折的发生率和特征以及与丧失步行能力相关的因素。
图表回顾包括身高、体重、双能 X 线吸收测定法、皮质类固醇使用、维生素 D、骨折史、肌肉力量、运动范围和计时表现测试（10 米步行/跑、Gowers 和四步）。患者根据骨折部位和骨折后步行能力丧失情况进行分组。
共确定了 287 例杜氏肌营养不良症患者，其中 53 例有骨折史。81%的患者首次骨折时年龄大于 9 岁，36.4%的患者在骨折后丧失了步行能力。背屈运动范围（骨折侧，P = 0.021）、股四头肌力量（右侧，P = 0.025）和肩部外展力量（右侧、左侧和骨折侧；P = 0.028、P = 0.027 和 P = 0.016）在组内差异显著。骨折后丧失步行能力的患者最初的背屈（右侧、左侧、骨折侧；2.25 与-7.29，P = 0.004；2.67 与-12，P = 0.001；和 2.41 与-7.42，P = 0.002）和 10 米步行/跑时间较慢（7.43 秒与 14.7 秒，P = 0.005）。
骨折是杜氏肌营养不良症患者的重大风险；行走速度较慢和踝关节挛缩都会增加骨折后丧失步行能力的风险。
要求 CME 学分：在 http://www.physiatry.org/JournalCME 上在线完成自我评估活动和评估。CME 目标：完成本文后，读者应能够：（1）确定与杜氏肌营养不良症患者骨折后步行能力丧失相关的主要因素；（2）确定杜氏肌营养不良症患者骨折的风险；（3）阐明与杜氏肌营养不良症患者骨折相关的特征。
高级。
学术物理治疗师协会由继续医学教育认证委员会认可，为医生提供继续医学教育。学术物理治疗师协会将此基于期刊的 CME 活动指定为最多 1.0 个 AMA PRA 类别 1 学分（TM）。医生只能要求与其参与活动相称的学分。
