痉挛性脑瘫患儿脊柱发育的影响因素

Factors affecting spinal development in children with spastic cerebral palsy

摘要:

[目的] 探讨痉挛性脑瘫患儿脊柱发育的影响因素。[方法] 共纳入本院收治的痉挛性脑瘫患者92 例，观察脊柱发育情况。采用单因素比较和多元线性回归分析，探讨脊柱发育的相关因素。[结果] 92 例患儿中，脊柱矢状面平衡55 例，占59.8%；脊柱矢状面失平衡37 例，占40.2%。单项因素比较，失衡组的脊柱矢状面轴向距离（sagittal vertical axis, SVA） [(8.2±2.5) cm vs (2.6±1.5) cm, P＜0.001]、股骨头向外侧移位值（migration percentage, MP） [(41.8±17.3)% vs (38.3±19.3)%, P＜0.001] 显著高于平衡组，而失衡组癫痫发生率显著低于平衡组[例(%), 0 (0.0) vs 6 (10.9), P=0.038]。两组年龄、性别、胎龄、出生体重、行走时间、瘫痪肢数、GMFCS 评分、体重、身高、BMI、AI 的差异均无统计学意义（P＞0.05）。SVA 绝对值与性别（r=0.231, P=0.027）、斜视情况（r=0.209, P=0.045）、GMFCS 评级（r=0.239, P=0.022）、MP 值（r=0.226, P=0.030）、AI 值（r=0.217, P=0.038）呈显著正相关。多元线性回归分析表明，GMFCS 评级、性别、AI 值是SVA 绝对值大的相关因素（P＜0.05），回归方程式为Y=-57.715+12.314GMFCS 分级+29.204 性别+1.965AI。[结论] 本研究发现，GMFCS 分级、AI 值、MP 值、性别和斜视情况影响痉挛性脑瘫患儿的脊柱发育，且GMFCS 分级、性别、AI 值可综合预测脑瘫脊柱SVA 值。

Abstract:

[Objective] To explore the factors affecting spinal development in children with spastic cerebral palsy. [Methods] A total of92 patients with spastic cerebral palsy admitted to our hospital were included into this study to observe the spinal development. Univariatecomparison and multiple regression analysis were used to search the factors related to spinal development. [Results] Among 92 children, 55(59.8%) were sagittal balance, whereas the remaining 37 (40.2%) were found sagittal spinal imbalance. Regarding to univariate comparison,the imbalance group proved significantly greater than the balance group in terms of deviation of sagittal vertical axis (SVA) [(8.2±2.5) cm vs(2.6±1.5) cm, P＜0.001] and lateral displacement of femoral head (migration percentage, MP) [(41.8±17.3)% vs (38.3±19.3)%, P＜0.001], whilethe incidence of epilepsy in the unbalanced group was significantly lower than that in the balanced group [case (%), 0 (0.0) vs 6 (10.9), P=0.038]. There were no significant differences in age, sex, gestational age, birth weight, walking time, number of paralyzed limbs, GMFCSscore, weight, height, BMI and AI between the two groups (P＞0.05). As consequence of paired correlation analysis, the absolute value of SVAwas significantly positively correlated to sex (r=0.231, P=0.027), strabismus (r=0.209, P=0.045), GMFCS scale (r=0.239, P=0.022), MP value(r=0.226, P=0.030), AI value (r=0.217, P=0.038). In addition, multiple linear regression analysis showed that GMFCS scale, gender and AIvalue were factors related to absolute value of SVA (P＜0.05), with a regression equation of Y=-57.715+12.314GMFCS scale +29.204 gender+1.965AI. [Conclusion] As findings of this study, the GMFCS scale, AI value, MP value, sex and strabismus impact spinal development ofchildren with spastic cerebral palsy, and GMFCS grade, sex and AI value might comprehensively predict spinal SVA value of cerebral palsy.