目的 用Meta分析的方法系统评价学龄儿童和青少年骨折(FR)发生的影响因素,并对FR发生与影响因素间的剂量-反应关系进行定量评价。方法 由两名研究人员独立检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、万方数据(Wanfang Data)和维普中文科技期刊全文数据库(VIP)2000年1月-2022年1月发表的与学龄儿童、青少年骨折发生相关的观察性研究,严格筛选文献,提取有效数据,应用Stata 16.0对效应量的比值比(OR)进行合并;采用Q检验和I2检验评价文献结局指标的异质性,并利用Begg's检验对发表偏倚情况进行检测,最后对学龄儿童骨折及其危险因素之间的剂量-反应关系进行定量分析。结果 共纳入14篇文献,包括2篇队列研究,3篇病例对照研究和9篇横断面研究,骨折组30 769例和对照组45 857例。Meta分析结果显示,男生(OR=2.91,95% CI:2.76~3.06)、中高强度体育活动(OR=1.55,95% CI:1.33~1.77)、骨折史(OR=3.56,95% CI:2.18~4.94)、7/8月份(OR=4.19,95% CI:3.30~5.08)、农村地区(OR=2.17,95% CI:1.02~3.32)为FR发生的危险因素,高中学段(OR=0.39,95% CI:0.11~0.67)为其保护因素。进一步的剂量-反应分析结果显示,年龄与FR发病风险之间呈非线性关系(χ2=13.26,P<0.01),体质量指数(χ2=6.71,P=0.082)、体育活动时间(χ2=3.18,P=0.107)和家庭收入水平(χ2=1.47,P=0.690)与FR发病风险之间呈线性关系。结论 性别、体育活动时间、骨折史、月份、城乡分布等因素会导致学龄儿童和青少年FR发生率的差异,而年龄对FR的影响呈现一种“先上升再下降”的非线性关系,上述结论尚需进一步临床研究及流行病学调查加以确证。
Abstract
Objective To systematically evaluate the influencing factors of fractures (FR) in school-age children and adolescents, and to assess the association based on a dose-response Meta-analysis. Methods Observational studies on the FR in school-age children and adolescents published from Jan.2000 to Jan.2022 were retrived from the databases of CBM, CNKI, Wanfang Data, and VIP.The articles were screened strictly to extract valid data.Stata 16.0 was applied to combine the odds ratio (OR) of effect sizes, Q-test and I2 test were used to evaluate the heterogeneity of outcome indicators in the literature, and Begg's test was used to detect publication bias.Finally, the dose-response relationship between FR and influencing factors was performed. Results A total of 14 articles (2 cohort studies, 3 case-control studies and 9 cross-sectional studies) involving 30 769 cases and 45 857 controls were included.Meta-analysis showed that boys (OR=2.91, 95%CI: 2.76 - 3.06), moderate-to-vigorous physical activities (OR=1.55, 95%CI: 1.33 - 1.77), FR history (OR=3.56, 95%CI: 2.18 - 4.94), July/August (OR=4.19, 95% CI: 3.30 - 5.08) and rural area (OR=2.17, 95%CI: 1.02 - 3.32) were risk factors for the developing of FR, while high secondary school (OR=0.39, 95%CI: 0.11 - 0.67) was a protective factor for FR.The dose-response analysis showed a non-linear correlation between age and FR risks (χ2=13.26, P<0.01).The correlations of body mass index (χ2=6.71, P=0.082), physical activity time (χ2=3.18, P=0.107) and household income (χ2=1.47, P=0.690) with FR risks were linear. Conclusion Gender, physical activity time, fracture history, month, and urban/rural area may lead to the differences in the incidence of FR in school-age children and adolescents, and the effect of age on FR showed a non-linear relationship of "increasing and then decreasing", which needs to be confirmed by further clinical studies and epidemiological surveys.
关键词
学龄儿童 /
青少年 /
骨折 /
Meta分析 /
剂量-反应分析
Key words
school-age children and adolescents /
fracture /
Meta-analysis /
dose-response analysis
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参考文献
[1] 吕红芝, 陈伟, 张晓琳, 等.中国居民骨折发病率流行病学调查设计[J].河北医科大学学报, 2015, 36(4):485-487.
Lyu HZ, Chen W, Zhang XL, et al.Design of an epidemiological survey on the incidence of fractures in the Chinese population[J].J Hebei Med Univ,2015, 36(4):485-487.(in Chinese)
[2] Ecott BG, To T, Beaton DE, et al.Risk of recurrent fracture:A population-based study[J].Pediatrics, 2019, 144(2):e20172552.
[3] Grgic O, Chung K, Shevroja E, et al.Fractures in school age children in relation to sex and ethnic background:The generation R study[J].Bone, 2019(121):227-231.
[4] 张玉青, 蔵晓鹭, 顾晞.心理干预对骨折儿童治疗依从性的影响[J].中国中医骨伤科杂志, 2014, 22(2):49-50.
Zhang YQ, Zang XL, Gu X.The impact of psychological interventions on adherence to treatment in children with fractures[J].Chin J Tradit Med Traumatol Orthop, 2014, 22(2):49-50.(in Chinese)
[5] Huh SY, Gprdon CM.Fractures in hospitalized children[J].Metabolism, 2013,62(3):315-325.
[6] Goulding A.Risk factors for fractures in normally active children and adolescents[J].Med Sport Sci, 2007(51):102-120.
[7] Stang A.Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in Meta-analyses[J].Eur J Epidemiol, 2010, 25(9):603-605.
[8] Orsini N, Li R, Wolk A, et al.Meta-analysis for linear and nonlinear dose-response relations:Examples, an evaluation of approximations, and software[J].Am J Epidemiol, 2012, 175(1):66-73.
[9] 董虹孛, 程红, 侯冬青, 等.学龄儿童青少年骨折新发特点及其影响因素的研究[J].中华流行病学杂志, 2021, 42(3):448-454.
Dong HB, Cheng H, Hou DQ, et al.Incidence and risk factors of pediatric fractures in school-age children and adolescents in Beijing[J].Chin J Epidemiol, 2021, 42(3):448-454.(in Chinese)
[10] 夏琍群, 沈蓉.911例儿童骨折原因及相关因素的回顾性分析[J].解放军护理杂志, 2008(13):38-39, 42.
Xia LQ, Shen R.Retrospective analysis of risk factors for 911 children fracture cases[J].Nurs J PLA, 2008(13):38-39, 42.(in Chinese)
[11] 杨晨辉, 程富礼.儿童股骨干骨折术后再骨折的影响因素分析[J].中华创伤骨科杂志, 2018, 20(9):813-817.
Yang CH, Cheng FL.Factors associated with refracture after surgery for femoral shaftfracture in children[J].Chin J Orthop Trauma, 2018, 20(9):813-817.(in Chinese)
[12] 屈凌霄, 罗春燕, 张喆, 等.上海市2011-2015学年中小学生伤害的流行特征分析[J].中华疾病控制杂志, 2018, 22(5):472-475, 503.
Qu LX, Luo CY, Zhang Z, et al.The epidemiology of injuries among elementary and middle school students in Shanghai from 2011 to 2015 academic year[J].Chin J Dis Control Prev, 2018, 22(5):472-475, 503.(in Chinese)
[13] 张涛, 刘晓光, 郭源, 等.北京地区10977例儿童骨折分析[J].中国矫形外科杂志, 2014, 22(24):2233-2237.
Zhang T, Liu XG, Guo Y, et al.Study on 10 977 cases of pediatric fractures in Beijing[J].Orthop J Chin, 2014, 22(24):2233-2237.(in Chinese)
[14] 杨昆鹏, 黄泽鹏, 周丽, 等.深圳市中小学生骨折现状及其影响因素分析[J].中国学校卫生, 2016, 37(3):371-375.
Yang KP, Huang ZP, Zhou L, et al.Characteristics of fractures and influencing factors among primary and middle school students in Shenzhen in 2015[J].Chin J School Health, 2016, 37(3):371-375.(in Chinese)
[15] 熊竹, 曾帅丹, 韩帅, 等.儿童肱骨髁上骨折区域性流行病学调查研究[J].中国骨与关节杂志, 2021, 10(3):210-214.
Xiong Z, Zeng SD, Han S, et al.Regional epidemiological investigation of humerus supracondylar fracture in Children[J].Chin J Bone Joint, 2021, 10(3):210-214.(in Chinese)
[16] 骆庆明, 陈嘉辉, 黄新萍, 等.东莞市1 809例儿童骨折的流行病学调查及直接经济负担分析[J].广东医科大学学报, 2018, 36(4):441-444.
Luo QM, Chen JH, Huang XP, et al.Epidemiological survey and direct economic burden analysis of 1809 fracture children in Dongguan city[J].J Guangdong Med Univ, 2018, 36(4):441-444.(in Chinese)
[17] 侯尚妍, 陈咏梅, 郑小凤, 等.0岁～12岁儿童意外伤害致骨折流行病学及临床特征分析[J].中国病案, 2021,22(6):78-82.
Hou SY, Chen YM, Zheng XF, et al.Analysis of Epidemiology and Clinical Features of Fractures Caused by Accidental Injuries in Children Aged 0 - 12[J].Chin Med Record, 2021,22(6):78-82.(in Chinese)
[18] 黎丹东, 李琳琳, 郭广惠, 等.新乡市某三级医院近5年儿童四肢骨折流行病学分析[J].中华灾害救援医学, 2019, 7(10):565-568.
Li DD, Li LL, Guo GH, et al.Epidemiological analysis of limb fractures in children in a tertiary hospital of Xinxiang City in recent five years[J].Chin J Disaster Med, 2019, 7(10):565-568.(in Chinese)
[19] 程家祥, 陈伟, 孙然, 等.204例儿童髋部骨折的流行病学特征[J].中国骨科临床与基础研究杂志, 2014, 6(1):8-12.
Cheng JX, Chen W, Sun R, et al.Clinical epidemiological features of 204 hip fractures in children[J].Chin J Clin Basic Orthop Res, 2014, 6(1):8-12.(in Chinese)
[20] 徐艳朋, 俞松.黔北地区儿童骨折特点分析[J].中国矫形外科杂志, 2018, 26(10):893-897.
Xu YP, Yu S.Characteristics of children's fracture in north Guizhou[J].Orthop J Chin, 2018, 26(10):893-897.(in Chinese)
[21] 张璞, 王欣, 高海涛, 等.儿童鼻骨骨折临床特点分析[J].河北医科大学学报, 2017, 38(3):301-305.
Zhang P, Wang X, Gao HT, et al.Analysis of the clinical characteristics in children's nasal bone fracture[J].J Hebei Med Univ, 2017, 38(3):301-305.(in Chinese)
[22] 刘红梅, 陈翠玲, 李英, 等.儿童上肢骨折的流行病学调查分析[J].护理研究, 2016, 30(6):735-737.
Liu HM, Chen CL, Li Y, et al.Epidemiological survey and analysis of upper limb fractures in children[J].Chin Nursing Res, 2016, 30(6):735-737.(in Chinese)
[23] Pirruccio K, Selemon NA, Ahn J, et al.American football is the youth sporting activity most commonly associated with acute vertebral fractures[J].Phys Sportsmed, 2021,49(3):348-354.
[24] 唐咏梅, 杨猛, 黄晓辉, 等.影响学龄儿童骨密度水平的环境因素分析[J].中国学校卫生, 2012,33(5):567-568.
Tang YM, Yang M, Huang XH, et al.Environmental factors to bone mineral density level of school children[J].Chin J School Health, 2012,33(5):567-568.(in Chinese)
[25] 张改, 陈玉梅, 李淑芳, 等.5 117例股骨颈骨折患者流行病学调查分析[J].天津护理, 2021, 29(5):505-508.
Zhang G, Chen YM, Li SF, et al.Epidemiological investigation of 5 117 patients with femoral neck fracture[J].Tianjin J Nursing, 2021, 29(5):505-508.(in Chinese)
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