Osteogenesis imperfecta and rib fractures in infancy.
Osteogenesis imperfecta and rib fractures in infancy.
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婴儿期成骨不全和肋骨骨折。
DOI：
10.1097/bpo.0000000000000149
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
C. Paterson
中科院分区：
文献类型：
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作者：
C. Paterson
致编辑：我带着一些担忧阅读了格里利等人的报告，他们发现新生儿在出生后的第一年内没有肋骨骨折。他们的结论是，在这个年龄段，OI不太可能是不明原因的肋骨骨折的原因。一个困难是，在OI和其他骨骼疾病肋骨骨折在第一年的生活几乎总是无症状的。格里利及其同事没有审查原始X线片，从他们的报告中也不清楚在相关时间获得了多少张胸部X线片。在已知的OI病例中，医生尽最大努力减少所需的X射线数量以减少辐射暴露。相反，如果怀疑儿童受到身体虐待，则进行非常全面的骨骼调查。由于肋骨骨折是无症状的，因此在后一种情况下最常见也就不足为奇了。虽然骨不连最常见的表现是有症状的骨干骨折，但肋骨骨折确实发生在已知病例中，并可能导致最初的误诊。2 - 5骨不连中肋骨骨折可能自发发生，如图1所示，该图显示了一名婴儿，后来被确定为III型骨不连，出生当天。不同年龄的多处肋骨骨折明显发生在子宫内。格里利等人的报告的第二个困难是，不明原因的肋骨骨折的鉴别诊断是在OI和儿童身体虐待之间。骨质疏松症并不是引起自发性肋骨骨折的唯一骨骼疾病。这些都是发现在广泛的代谢紊乱，包括骨病的早产儿，维生素D缺乏症，8，9铜缺乏症，10和其他原因不明的疾病。11，12重要的是要知道，肋骨骨折在婴儿期有一个广泛的鉴别诊断。
To the Editor: I read with some concern the report of Greeley et al. They found no rib fractures in infants with osteogenesis imperfecta (OI) in the first year of life. They concluded that OI was unlikely to be the cause of unexplained rib fractures at this age. One difficulty is that in OI and other bone disorders rib fractures in the first year of life are almost always asymptomatic. The original x-rays were not reviewed by Greeley and colleagues, and it is not clear from their report how many chest x-rays were obtained at the relevant time. In known cases of OI, physicians make great efforts to minimize the number of x-rays requested to reduce radiation exposure. In contrast, when child physical abuse is suspected, very full skeletal surveys are undertaken. As rib fractures are asymptomatic it is not surprising that they are most frequently found in the latter situation. Although the most common presentation of OI is a symptomatic diaphyseal fracture, rib fractures do occur in known cases and may lead to initial misdiagnosis.2–5 That rib fractures may occur spontaneously in OI is illustrated by Figure 1, which shows an infant, later identified as having OI type III, on the day of birth. Multiple rib fractures of various ages had clearly occurred in utero. A second difficulty with the report by Greeley et al is the implication that the differential diagnosis of unexplained rib fractures is between OI and child physical abuse. OI is not the only bone disorder to cause spontaneous rib fractures. These are found in a wide range of metabolic disorders including osteopathy of prematurity, vitamin D deficiency,8,9 copper deficiency,10 and other unexplained disorders.11,12 It is important to be aware that rib fractures during infancy have a wide differential diagnosis.