中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2006年
32期
178-180
,共3页
背景:临床上常见3～15岁少儿不明原因的膝关节夜间痛,且反复发作.大多数称之为"生长痛".目的:分析少儿膝关节夜间痛的相关因素,观察阿法D3的干预效应.设计:病例-对照分析,自身前后对照分析.单位:上海复旦大学附属金山医院骨科.对象:选择1998-06/2002-08在上海复旦大学附属金山医院门诊治疗的反复发作的不明原因膝关节夜间痛患儿22例,为膝关节夜间痛组,年龄3～15岁.以同期创伤骨折愈合半年之后的患儿20例为对照组.方法:对膝关节夜间痛组患儿采用骨矿化剂阿法D3 0.25 μg口服,1次/d,连续1周,停药观察3周,4周为1个疗程.如仍有夜间痛或酸痛停止后又出现者,再继续1个疗程,直至夜间痛消失.测定常有膝关节夜间痛组与对照组患儿的骨钙素、血钙、磷、镁及碱性磷酸酶和骨密度,并观察膝关节夜间痛组采用阿法D3治疗前和治疗后1,3,6个月骨钙素的指标和夜间膝痛的变化.1个疗程结束后,复查血钙、磷、镁、碱性磷酸酶、骨钙素、降钙素、尿常规和膝关节X射线平片,6个月复查骨密度.主要观察指标:①膝关节夜间痛患儿治疗前后检测血钙、磷、镁、血碱性磷酸酶.②膝关节夜间痛患儿治疗前和治疗后1,3,6个月骨钙素水平,治疗前和治疗后6个月查骨密度;对照组在骨折愈合后6个月和1年时查上述指标.③阿法D3治疗的疗效.结果:42例全部进入结果分析.①膝关节夜间痛患儿治疗前后检测血钙、磷、镁、血碱性磷酸酶均正常.②对照组患儿骨折愈合后1年骨钙素明显低于骨折愈合后6个月[(7.06±0.74),(7.44±1.16)μg/L,P＜0.01];膝关节夜间痛组患儿治疗前为15.98μg/L,显著高于对照组,治疗后1,3,6个月分别为(12.12±2.2),(10.6±81.31),(7.60±0.95)μg/L,治疗前后比较差异显著(P＜0.05).③两组患儿骨密度比较差异无显著性意义(P＞0.05).④膝夜间酸痛夜间疼痛在采用阿法D3治疗后症状改善或消失,时间为9～83 d.结论:膝关节夜间痛少儿虽然够不上佝偻病的诊断标准,但仍然与骨的矿化不足有一定的相关性;临床上对于不明原因的少儿膝关节夜间痛可以骨钙素测定作为监测手段;运用骨矿化剂阿法D3治疗少儿膝关节夜间痛有明显疗效.
揹景:臨床上常見3～15歲少兒不明原因的膝關節夜間痛,且反複髮作.大多數稱之為"生長痛".目的:分析少兒膝關節夜間痛的相關因素,觀察阿法D3的榦預效應.設計:病例-對照分析,自身前後對照分析.單位:上海複旦大學附屬金山醫院骨科.對象:選擇1998-06/2002-08在上海複旦大學附屬金山醫院門診治療的反複髮作的不明原因膝關節夜間痛患兒22例,為膝關節夜間痛組,年齡3～15歲.以同期創傷骨摺愈閤半年之後的患兒20例為對照組.方法:對膝關節夜間痛組患兒採用骨礦化劑阿法D3 0.25 μg口服,1次/d,連續1週,停藥觀察3週,4週為1箇療程.如仍有夜間痛或痠痛停止後又齣現者,再繼續1箇療程,直至夜間痛消失.測定常有膝關節夜間痛組與對照組患兒的骨鈣素、血鈣、燐、鎂及堿性燐痠酶和骨密度,併觀察膝關節夜間痛組採用阿法D3治療前和治療後1,3,6箇月骨鈣素的指標和夜間膝痛的變化.1箇療程結束後,複查血鈣、燐、鎂、堿性燐痠酶、骨鈣素、降鈣素、尿常規和膝關節X射線平片,6箇月複查骨密度.主要觀察指標:①膝關節夜間痛患兒治療前後檢測血鈣、燐、鎂、血堿性燐痠酶.②膝關節夜間痛患兒治療前和治療後1,3,6箇月骨鈣素水平,治療前和治療後6箇月查骨密度;對照組在骨摺愈閤後6箇月和1年時查上述指標.③阿法D3治療的療效.結果:42例全部進入結果分析.①膝關節夜間痛患兒治療前後檢測血鈣、燐、鎂、血堿性燐痠酶均正常.②對照組患兒骨摺愈閤後1年骨鈣素明顯低于骨摺愈閤後6箇月[(7.06±0.74),(7.44±1.16)μg/L,P＜0.01];膝關節夜間痛組患兒治療前為15.98μg/L,顯著高于對照組,治療後1,3,6箇月分彆為(12.12±2.2),(10.6±81.31),(7.60±0.95)μg/L,治療前後比較差異顯著(P＜0.05).③兩組患兒骨密度比較差異無顯著性意義(P＞0.05).④膝夜間痠痛夜間疼痛在採用阿法D3治療後癥狀改善或消失,時間為9～83 d.結論:膝關節夜間痛少兒雖然夠不上佝僂病的診斷標準,但仍然與骨的礦化不足有一定的相關性;臨床上對于不明原因的少兒膝關節夜間痛可以骨鈣素測定作為鑑測手段;運用骨礦化劑阿法D3治療少兒膝關節夜間痛有明顯療效.
배경:림상상상견3～15세소인불명원인적슬관절야간통,차반복발작.대다수칭지위"생장통".목적:분석소인슬관절야간통적상관인소,관찰아법D3적간예효응.설계:병례-대조분석,자신전후대조분석.단위:상해복단대학부속금산의원골과.대상:선택1998-06/2002-08재상해복단대학부속금산의원문진치료적반복발작적불명원인슬관절야간통환인22례,위슬관절야간통조,년령3～15세.이동기창상골절유합반년지후적환인20례위대조조.방법:대슬관절야간통조환인채용골광화제아법D3 0.25 μg구복,1차/d,련속1주,정약관찰3주,4주위1개료정.여잉유야간통혹산통정지후우출현자,재계속1개료정,직지야간통소실.측정상유슬관절야간통조여대조조환인적골개소、혈개、린、미급감성린산매화골밀도,병관찰슬관절야간통조채용아법D3치료전화치료후1,3,6개월골개소적지표화야간슬통적변화.1개료정결속후,복사혈개、린、미、감성린산매、골개소、강개소、뇨상규화슬관절X사선평편,6개월복사골밀도.주요관찰지표:①슬관절야간통환인치료전후검측혈개、린、미、혈감성린산매.②슬관절야간통환인치료전화치료후1,3,6개월골개소수평,치료전화치료후6개월사골밀도;대조조재골절유합후6개월화1년시사상술지표.③아법D3치료적료효.결과:42례전부진입결과분석.①슬관절야간통환인치료전후검측혈개、린、미、혈감성린산매균정상.②대조조환인골절유합후1년골개소명현저우골절유합후6개월[(7.06±0.74),(7.44±1.16)μg/L,P＜0.01];슬관절야간통조환인치료전위15.98μg/L,현저고우대조조,치료후1,3,6개월분별위(12.12±2.2),(10.6±81.31),(7.60±0.95)μg/L,치료전후비교차이현저(P＜0.05).③량조환인골밀도비교차이무현저성의의(P＞0.05).④슬야간산통야간동통재채용아법D3치료후증상개선혹소실,시간위9～83 d.결론:슬관절야간통소인수연구불상구루병적진단표준,단잉연여골적광화불족유일정적상관성;림상상대우불명원인적소인슬관절야간통가이골개소측정작위감측수단;운용골광화제아법D3치료소인슬관절야간통유명현료효.
BACKGROUND: It is often seen in clinical practice that children, aged3-15 years, suffer from knee pain of unknown cause at night, which occurs frequently. Most of them can be called "pain of growth".OBJECTIVE: To analyze the related factors of knee pain in adolescents and observe the interventional effect of alpha-D3 (α-D3).DESIGN: Case control analysis, self-control analysis SETTING: Department of Orthopaedics, Jinshan Hospital Affiliated to Shanghai Fudan University PARTICIPANTS: We admitted 22 children outpatients, aged 3 to 15years, who suffered from recurrent attack of knee pain of unknown reasons and received treatment in Jinshan Hospital Affiliated to Shanghai Fudan University from June 1998 to August 2002, servingas group A. Another 20children outpatients of fracture recovered for half a year were recruited simultaneously, serving as Group B (control group).METHODS: Group A adopted the therapy of α- D3 of 0.25 μg taken orally once everyday for successive 7 days then stopped to observe the symptoms for the next three weeks. Four weeks was one therapeutic course.If the pains were still alive or reoccurred, another therapy period was needed until they vanished. The contents of bone gla protein (BGP), blood calcium (Ca2+), blood phosphorus (P3+), blood magnesium (Mg2+), alkaline phosphatase (ALP) and bone mineral density (BMD) of patients were detected between Group A and Group B. GBP index and change of pain in knee at night was observed with α-D3 before therapy and 1,3 and 6months after therapy. After one therapy period, the levels of blood Ca2+, P3+,Mg2+, ALP, BGP, CT, urine and X-ray of knees were detected again, so was BMD after 6 months.MAIN OUTCOME MEASURES: ① Blood Ca2+, P3+, Mg2+, ALP contents of children patients were detected before and after therapy . ② In the Group A, content of BGP was detected before and 1,3 and 6 months after therapy, and BMD before and 6 months after therapy; The above indexes were detected 6 months and one year after bone fracture healing in the control group. ③ Therapeutic effect of α-D3.RESULTS: All the 42 patients entered the stage of result analysis. ① The levels of blood Ca2+, P3+, Mg2+, ALP of patients who suffered pain in knee were all normal before and after therapy . ②BGP content of patients in the control group was significantly lower 1 year after bone fracture healing than 6 months after bone fracture healing [(7.06±0.74), (7.44±1.16)μg/L,P ＜ 0.01]; BGP content of patients in Group A was 15.98 μg/L before therapy , which was significantly higher than that in the control group .BGP content was (12.12±2.2), (10.6±81.31), (7.60±0.95)μg/L , respectively in 1,3 and 6 months after therapy. There was significant difference of BGP content between before and after therapy (P ＜ 0.05). ③ There was no significant difference of BMD of patients between two groups (P ＞ 0.05).④ Symptoms of pain in knee at night improved or disappeared after α-D3therapy, and the therapeutic time was 9 to 83 days.CONCLUSION: Although the knee pain of adolescents and children at night can not reach the diagnostic criterion of rachitis, it is still correlated with the deficiency of bone mineralization, in clinical practice, the BGP determination should be used as a means of monitoring the pain of unknown cause. There is significant effect using vitamin D3 in treatment of knee pain of children at night.
