Penn State College of Medicine.
Penn State Hershey Medical Center, Penn State Health Internal Medicine.
J Pediatr Orthop. 2021 Mar 1;41(3):e279-e284. doi: 10.1097/BPO.0000000000001731.
Scurvy, or vitamin C deficiency, is rare. The goal of this study is to highlight the common risk factors and identify the orthopaedic presentation of scurvy in children.
A retrospective chart and radiograph review was performed of all patients consulted to the pediatric orthopaedic service from 2010 to 2019 who ultimately had the diagnosis of scurvy confirmed by an abnormally low serum vitamin C level. Data extracted included: patient age, sex, neurological conditions, prematurity, psychiatric conditions, dietary abnormalities, bone pain, arthritis, limb swelling, inability to walk, skin changes, child abuse evaluations, radiographic findings, additional vitamin deficiencies, lab studies, additional tests, response to treatment. Descriptive statistics were performed.
Nine patients (7 males, 2 females) with scurvy were studied. The average age was 7 years (range 3 to 13 y). The average body mass index was 21.4 (range, 14 to 30). Five had autism, 2 had a neurological disorder. Two had been born premature. Two had a psychiatric disorder. Seven had an abnormal diet. One presented with bone pain. Four presented with limb swelling. Seven had unilateral and 2 had bilateral leg symptoms. Five presented with inability to walk. Six demonstrated skin changes with ecchymosis or petechiae. Three presented with gingival bleeding. Radiographic findings included subperiosteal hematoma in 2, ring epiphysis in 3, Pelkan spurs in 1, metaphyseal white lines (Frankel sign) in 6, and a metaphyseal zone of rarefaction (Trummerfeld zone) in 3. Seven had additional vitamin deficiencies including: A, B1, B6, B9, D, E, K, iron and zinc. Four had a bone marrow biopsy and 1 had lumbar puncture. All were anemic. The average erythrocyte sedimentation rate was 25.7 (range 6 to 35) and C-reactive protein was 1.5 (range 0.55 to 5.64). Six had a computed tomography, 3 had a magnetic resonance imaging. After treatment with vitamin C lasting 3.4 months (range, 2 wk to 7 mo), all symptoms gradually resolved, including leg pain and swelling. All children began to walk.
The pediatric orthopaedic surgeon should have an increased awareness about the diagnosis of scurvy when consulted on a child with bone pain or inability to walk. The most common orthopaedic presentation was the refusal to bear weight, the most common radiographic finding was the metaphyseal line of increased density (Frankel sign) and treatment with vitamin c supplementation was excellent in all cases.
坏血病，又称维生素 C 缺乏症，较为罕见。本研究旨在强调其常见的危险因素，并确定儿童坏血病的骨科表现。
回顾性分析了 2010 年至 2019 年期间因疑似坏血病而向儿科骨科就诊的所有患者的病历和影像学资料，最终通过血清维生素 C 水平异常降低确诊。提取的数据包括：患者年龄、性别、神经疾病、早产、精神疾病、饮食异常、骨痛、关节炎、四肢肿胀、无法行走、皮肤变化、虐待评估、影像学表现、其他维生素缺乏、实验室检查、其他检查、治疗反应。进行描述性统计分析。
共研究了 9 例坏血病患儿（7 名男性，2 名女性）。平均年龄为 7 岁（范围 3 至 13 岁）。平均体重指数为 21.4（范围 14 至 30）。5 例患儿患有自闭症，2 例有神经疾病。2 例患儿早产。2 例有精神疾病。7 例饮食异常。1 例出现骨痛。4 例出现四肢肿胀。7 例为单侧，2 例为双侧腿部症状。5 例出现无法行走。6 例出现皮肤瘀斑或瘀点。3 例出现牙龈出血。影像学表现包括 2 例骨膜下血肿、3 例环状骨骺、1 例 Pelkan 骨刺、6 例干骺端白线（Frankel 征）和 3 例干骺端疏松区（Trummerfeld 区）。7 例患儿有其他维生素缺乏，包括 A、B1、B6、B9、D、E、K、铁和锌。4 例行骨髓活检，1 例行腰椎穿刺。所有患儿均有贫血。红细胞沉降率平均为 25.7（范围 6 至 35），C 反应蛋白为 1.5（范围 0.55 至 5.64）。6 例行计算机断层扫描，3 例行磁共振成像。经维生素 C 治疗 3.4 个月（范围 2 周至 7 个月）后，所有症状逐渐缓解，包括腿部疼痛和肿胀。所有患儿均开始行走。
当儿童出现骨痛或无法行走时，儿科骨科医生应提高对坏血病诊断的认识。最常见的骨科表现为拒绝对称负重，最常见的影像学表现为干骺端密度增加线（Frankel 征），所有病例经维生素 C 补充治疗后均取得良好效果。
