痉挛型脑瘫患儿髋脱位的相关因素

Factors associated with hip dislocation of spastic cerebral palsy in children

摘要:

[目的] 探究痉挛型脑瘫患儿髋脱位的相关因素。[方法] 2014 年1 月—2021 年12 月就诊于本院痉挛型脑瘫患儿235 例（共470 髋） 纳入本研究，其中男172 例，女63 例，平均年龄（8.3±3.2） 岁。按髋关节是否脱位将患者分为两组，采用单项因素比较和多因素逻辑回归分析探讨影响痉挛型脑瘫患儿髋脱位的相关因素，并研究临床与影像指标的单项相关性。[结果] 235 例中，确诊脱位73 例，占31.1%。单项因素比较，脱位组年龄显著小于未脱位组[(7.6±3.2) 岁vs (8.6±3.3) 岁, P=0.048]；脱位组GMFCS 分级明显高于未脱位组[GMFCS I/II/lIII/IV/V, (5/23/25/20/0) vs (42/56/46/18/0), P=0.001]；脱位组股骨头外移百分比（migration percentage, MP） [(43.7±14.1)% vs (25.0±5.7)%, P=0.001]，头干角（head-shaft angle, HAS） [(164.3±8.1)° vs(160.9±8.5)°, P=0.010]、髋臼指数（acetabular index, AI） [(32.1±9.5)° vs (21.9±7.4)°, P=0.001] 显著大于未脱位组。逻辑回归分析表明， AI（OR=1.131, 95%CI 1.080~1.184, P＜0.001）、HSA（OR=1.076, 95%CI 1.027~1.128, P=0.002）、GMFCS（OR=1.478, 95%CI1.029~2.121, P=0.003） 是发生脱位的独立危险因素。临床与影像指标的单项相关分析显示，年龄与MP（r=-0.187, P=0.004）、HSA （r=-0.287, P＜0.001）、NSA （r=-0.306, P＜0.001）、AI （r=-0.264, P＜0.001） 均具有显著负相关性；而GMFCS 与MP （r=0.375, P＜0.001）、HSA（r=0.192, P=0.003）、NSA（r=0.235, P＜0.001）、AI（r=0.355, P＜0.001） 均具有显著正相关性。[结论] 在痉挛型脑瘫儿童中，粗大运动功能的下降和股骨近端、髋臼的发育畸形均与髋脱位的发生密切相关。

Abstract:

[Objective] To explore the factors related to hip dislocation in children with spastic cerebral palsy. [Methods] A total of235 children with spastic cerebral palsy (470 hips) admitted to our hospital from January 2014 to December 2021 were included in thisstudy, including 172 males and 63 females, aged (8.3±3.2) years. The patients were divided into two groups according to whether the hipwas dislocated. Univariate comparison and multi-factor logistic regression analysis were used to explore the factors related to dislocation ofthe hip in children with spastic cerebral palsy, additionally, simple correlations between clinical and imaging indicators were searched. [Re-sults] Of the 235 children, 73 cases were definitively diagnosed of dislocation, accounting for 31.1%. In term of univariate comparison, thedislocation group proved significantly younger than the non-dislocation group [(7.6±3.2) years vs (8.6±3.3) years, P=0.048], the former hadsignificantly poor GMFCS grade than the latter [GMFCS I/II/lIII/IV/V, (5/23/25/20/0) vs (42/56/46/18/0), P=0.001], whereas the dislocationgroup had significantly greater migration percentage of femoral head (MP) [(43.7±14.1)% vs (25.0±5.7)%, P=0.001], head-shaft angle(HAS) [(164.3±8.1)° vs (160.9±8.5)°, P=0.010], and acetabular index (AI) [(32.1±9.5)° vs (21.9±7.4)°, P=0.001] than the non-dislocationgroup. As results of logistic regression analysis, the AI (OR=1.131, 95%CI 1.080~1.184, P=0.001), HSA (OR=1.076, 95%CI 1.027~1.128,P=0.002), and GMFCS (OR=1.478, 95%CI 1.029~2.121, P=0.003) were independent risk factors for dislocation. Regarding simple correla-tion analyses, the age proved significantly negative correlation with MP (r=-0.187, P=0.004), HSA (r=-0.287, P＜0.001), NSA (r=-0.306,P＜0.001) and AI (r=-0.264, P＜0.001), whereas the GMFCS was significantly positive correlation with MP (r=0.375, P＜0.001), HSA (r=0.192, P=0.003), NSA (r=0.235, P＜0.001), AI (r=0.355, P＜0.001). [Conclusion] In children with spastic cerebral palsy, the decline ofgross motor function and the developmental deformity of proximal femur and acetabulum are closely related to the occurrence of hip disloca-tion.