儿童痉挛型脑性瘫痪股骨头外移的相关因素△（开放获取）

Factors related to femoral head lateral displacement in children with spastic cerebral palsy

摘要:

[目的]探讨影响痉挛型脑瘫患儿髋关节脱位的相关因素。[方法]本院 2016 年 1 月—2024 年 1 月收治的 322 例痉挛型脑瘫患儿纳入本研究。分别按照粗大运动功能分级 （gross motor function classification system, GMFCS）、改良 Ashworth 分级 （modified Ashworth scale, MAS） 和股骨头偏移百分比 （migration percentage, MP） 分组，比较不同组临床与影像指标差异。对 MP 与临床、影像等指标进行两两相关分析。行多元线性逐步回归分析，评价相关因素的作用大小。[结果] 根据 GMFCS 分组，其中 I 级 57 例 （17.7%），II 级 92 例 （28.6%），III 级 82 例 （25.5%），IV 级 60 例 （18.6%），V 级 31 例 （9.6%）。根据 MAS 分组，其中 1 级 22 例（6.8%），2 级 131 例（40.7%），3 级 127 例（39.4%），4 级 42 例（13.1%）。根据 MP 分组，其中≤ 20% 组 42 例 （13.0%），20%~30% 组 109 例 （33.9%），30%~40% 组 90 例 （28.0%），≥40% 组 81 例 （25.1%）。GMFCS 与 MP 具有显著正相关 （r=0.621, P＜0.001），MAS 与 MP 具有显著正相关 （r=0.694, P＜0.001），NSA 与 MP 具有显著正相关 （r=0.701, P＜0.001），AI 与 MP 具有显著正相关性 （r=0.682, P＜0.001）。MP 与孕龄、出生体重、性别、年龄及入院体重无显著相关性 （P＞0.05）。多元线性逐步回归方程为 Y （MP） =-49.095+0.540×AI+4.887×MAS+0.326×NSA+2.291×GMFCS。[结论] GMFCS、 MAS、NSA 和 AI 是痉挛型脑瘫患儿股骨头外移的相关因素。

Abstract:

[Objective] To investigate the factors related to hip dislocation in children with spastic cerebral palsy. [Methods] This study involved a total of 322 children who visited our hospital and were diagnosed with spastic cerebral palsy from January 2016 to January 2024. The gross motor function classification system (GMFCS), modified Ashworth scale (MAS) and femoral head migration percentage (MP) were used to hierarchically compare differences in clinical and imaging indicators among the subgroups. The pairwise correlation between MP and clinical and imaging indexes and multiple linear stepwise regression analysis was performed to evaluate the role of related factors. [Results] According to GMFCS, there were 57 cases (17.7%) in grade I, 92 cases (28.6%) in grade II, 82 cases (25.5%) in grade III, 60 cases (18.6%) in grade IV, and 31 cases (9.6%) in grade V. According to MAS grouping, there were 22 cases (6.8%) in grade 1, 131 cases (40.7%) in grade 2, 127 cases (39.4%) in grade 3, and 42 cases (13.1%) in grade 4. According to MP group, there were 42 cases (13.0%) in ≤20% group, 109 cases (33.9%) in 20%~30% group, 90 cases (28.0%) in 30%~40% group, and 81 cases (25.1%) in ≥40% group. As results of pairwise correlation, GMFCS had a significant positive correlation with MP (r=0.621, P＜0.001), MAS had a significant positive correlation with MP (r=0.694, P＜0.001), neck-shaft angle (NSA) of the femur had a significant positive correlation with MP (r=0.701, P＜ 0.001). In addition, there was significant positive correlation between acetabular index (AI) and MP (r=0.682, P＜0.001). However, MP had no significant correlation with gestational age, birth weight, sex, age and admission weight (P＞0.05). The multiple linear stepwise regression equation was Y (MP) = -49.095+0.540×AI+4.887×MAS+0.326×NSA+2.291×GMFCS. [Conclusion] The GMFCS, MAS, NSA and AI are related factors of femoral head lateral displacement in children with spastic cerebral palsy.