脊髓灰质炎幸存者老年人群中的骨折：明尼苏达州奥尔姆斯特德县的一项基于社区的研究

Fractures in an aging population of poliomyelitis survivors: a community-based study in Olmsted County, Minnesota.

作者信息

Goerss J B, Atkinson E J, Windebank A J, O'Fallon W M, Melton L J

机构信息

Department of Medical Genetics, Mayo Clinic Rochester, Minnesota 55905.

出版信息

Mayo Clin Proc. 1994 Apr;69(4):333-9. doi: 10.1016/s0025-6196(12)62217-4.

DOI:10.1016/s0025-6196(12)62217-4

PMID:8170177

Abstract

OBJECTIVE

To determine the incidence of fractures in a cohort of survivors of paralytic poliomyelitis ("polio").

DESIGN

We conducted a population-based retrospective cohort study of residents of Olmsted County, Minnesota, who had an initial diagnosis of polio between 1935 and 1959 and survived the acute illness.

MATERIALS AND METHODS

A comprehensive medical records-linkage system was used to retrieve all diagnoses of poliomyelitis in residents of the county for the specified 25-year period. For the 277 study subjects, the medical records were searched for the occurrence of fracture from the time of initial diagnosis of polio until death or the most recent clinical contact. All fractures were classified on the basis of type of associated injury and skeletal site of involvement. The influence of polio on the incidence of fractures was evaluated by estimating the cumulative incidence of new fractures after the diagnosis of polio and the standardized morbidity ratio. The relative influence of various factors on the risk of fracture was determined.

RESULTS

Of the 277 Olmsted County residents with polio, 87 experienced 161 fractures, and the estimated cumulative incidence of any fracture after 40 years was 48%. The cumulative incidence of any limb fracture was 41% and was less than the expected value of 44% (P = 0.001). Only the risk of distal femoral and proximal humeral fractures was significantly higher than that among Olmsted County residents in general. The increased risk seemed to be associated with weakness and disuse of the involved limbs rather than with generalized osteoporosis. Theoretically, a greater capacity for bone remodeling in response to changes in muscle use might have protected patients with polio in childhood, but such persons were as likely to sustain a fracture as those with adult-onset poliomyelitis.

CONCLUSION

These data indicate that survivors of paralytic poliomyelitis do not have an unusual risk of fracture except in affected limbs.

摘要

目的

确定麻痹性脊髓灰质炎（“小儿麻痹症”）幸存者队列中骨折的发生率。

设计

我们对明尼苏达州奥尔姆斯特德县的居民进行了一项基于人群的回顾性队列研究，这些居民在1935年至1959年间首次被诊断为小儿麻痹症并在急性疾病中存活下来。

材料与方法

使用全面的医疗记录链接系统检索该县居民在指定的25年期间所有小儿麻痹症诊断。对于277名研究对象，在医疗记录中搜索从首次诊断小儿麻痹症到死亡或最近一次临床接触期间骨折的发生情况。所有骨折均根据相关损伤类型和受累骨骼部位进行分类。通过估计小儿麻痹症诊断后新骨折的累积发生率和标准化发病比来评估小儿麻痹症对骨折发生率的影响。确定各种因素对骨折风险的相对影响。

结果

在277名患有小儿麻痹症的奥尔姆斯特德县居民中，87人经历了161次骨折，40年后任何骨折的估计累积发生率为48%。任何肢体骨折的累积发生率为41%，低于预期值44%（P = 0.001）。只有股骨远端和肱骨近端骨折的风险明显高于奥尔姆斯特德县一般居民。风险增加似乎与受累肢体的无力和废用有关，而不是与全身性骨质疏松有关。从理论上讲，儿童期患有小儿麻痹症的患者可能因对肌肉使用变化的骨重塑能力更强而受到保护，但这些人与成年后发病的小儿麻痹症患者骨折的可能性相同。