Purpose: Non-ambulatory persons with cerebral palsy are prone to low bone mineral density. In ambulatory persons with cerebral palsy, bone mineral density deficits are expected to be small or absent, but a consensus conclusion is lacking. In this systematic review bone mineral density in ambulatory persons with cerebral palsy (Gross Motor Function Classification Scales I–III) was studied.
Materials and methods: Medline, Embase, and Web of Science were searched. According to international guidelines, low bone mineral density was defined as Z-score?≤??2.0. In addition, we focused on Z-score?≤??1.0 because this may indicate a tendency towards low bone mineral density.
Results: We included 16 studies, comprising 465 patients aged 1–65?years. Moderate and conflicting evidence for low bone mineral density (Z-score?≤??2.0) was found for several body parts (total proximal femur, total body, distal femur, lumbar spine) in children with Gross Motor Function Classification Scales II and III. We found no evidence for low bone mineral density in children with Gross Motor Function Classification Scale I or adults, although there was a tendency towards low bone mineral density (Z-score?≤??1.0) for several body parts.
Conclusions: Although more high-quality research is needed, results indicate that deficits in bone mineral density are not restricted to non-ambulatory people with cerebral palsy.
Implications for Rehabilitation
Although more high-quality research is needed, including adults and fracture risk assessment, the current study indicates that deficits in bone mineral density are not restricted to non-ambulatory people with CP.
Health care professionals should be aware that optimal nutrition, supplements on indication, and an active lifestyle, preferably with weight-bearing activities, are important in ambulatory people with CP, also from a bone quality point-of-view.
If indicated, medication and fall prevention training should be prescribed.
This study was performed to assess the prevalence of signs and symptoms related to cervical spine disorders (CSD) in subgroups of patients with temporomandibular disorders (TMD) and to compare TMD patients and CSD patients with regard to the results of orthopaedic cervical spine tests. One hundred and eleven consecutive patients with TMD and 103 consecutive patients with signs and symptoms of CSD were examined. The results indicated that there is a considerable overlap in the signs and symptoms of patients with TMD and patients with CSD. Signs and symptoms on neck extension occurred more often in CSD patients than in subgroups of TMD patients. No significant differences in upper cervical extension, neck flexion, and shoulder girdle function were found between CSD patients and subgroups of patients with TMD. Patients with CSD reported neck pain during active and passive movements of the neck more often than the subgroups of patients with TMD. TMD patients and CSD patients did not differ with regard to pain on shoulder girdle function and palpation of the shoulder girdle. Logistic regression analyses showed that orthopaedic tests of the cervical spine are of minor importance in discriminating between patients with TMD and patients with CSD. It is concluded that TMD with a myogenous involvement in contrast to TMD with only an arthrogenous involvement should no longer be viewed as a local disorder of the stomatognathic system. The upper quarter, including the stomatognathic system, cervical spine, and shoulder girdle, should be evaluated in patients with more complex or persistent symptoms in the head and neck region. 相似文献
summary The influence of a three-layered flexible coating of Polyactive® on bone stress distribution was investigated by three-dimensional finite element models of mandibular bone, in which a titanium implant (coated or uncoated) was located. Poly-active® is a system of poly(ethylene oxide) poly(butylene terephthalate) segmented co-polymers with bone-bonding capacity. In the case of sagittal and transversal loading, the use of a Polyactive® coating reduced both the minimum principal stress in the bone and the compressive radial stress at the bone-implant interface. However, it raised the maximum principal and the tensile radial stress. In the case of vertical loading, the application of a flexible coating reduced the compressive radial stress at the bone-implant interface around the neck of the implant by a factor of 6.6 and the tensile radial stress by a factor of 3.6. Variations in composition and thickness of the coating did not affect the results significantly. 相似文献
This study examined the prevalence of endodontic treatment in a group of 184 Dutch adults, and determined the periapical status of all teeth using panoramic radiographs. The results indicate that in this group, 2.3% of the teeth were root-filled, and that 5.2% of all non-endodonticallv treated teeth showed signs of periapical pathology. Around the apices of 39.2% of the endodontically treated teeth in this survey, radiographic signs of periapical pathology were observed. Using the level of the root canal filling as a criterion for evaluating the quality of the root canal treatment, 50.6% of the endodontic treatments were qualified as inadequate. There was a significant correlation between the presence of periapical pathology and underfilling of the root canal(s). 44.6% of the patient sample had at least one tooth with radiographic signs of periapical pathology, indicating a substantial future need for endodontic treatment. 相似文献
The effect of post preparation on the apical seal of endodontically treated specimens was studied. The canals prepared in bovine bone were instrumented and obturated using five obturation techniques: the silver point technique, the lateral condensation of gutta-percha technique, the warm vertical condensation of gutta-percha technique, the Hygenic Ultrafil injection system and the Obtura technique. In addition to these five control groups, the five experimental groups were also subjected to post preparation. In the latter group, the gutta-percha was removed with an engine-driven root canal reamer 48 hours after obturation. Both the control and experimental groups were suspended in a 0.5 per cent crystal violet solution for 48 hours. After dye penetration, the specimens were immersed in liquid nitrogen and then split longitudinally. Linear measurements of the resultant apical dye leakage were determined by image processing. For each obturation technique, all specimens in both the control and experimental groups were recorded if they showed leakage. Using Fisher's exact probability test, it was shown that there was no significant difference between the obturation techniques used. 相似文献