痉挛型脑瘫儿童粗大运动功能分级与髋腰发育的关系  

Relationship between the gross motor function classification system and hip and lumbar spine development in children with spastic cerebral palsy

作　　者：刘港 刘丽[1] 徐林[1] 马超 邓博文 蒋昇源 于睿钦 赵毅 穆晓红[1] LIU Gang;LIU Li;XU Lin;MA Chao;DENG Bo-wen;JIANG Sheng-yuan;YU Rui-qin;ZHAO Yi;MU Xiao-hong(Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine,Beijing100010,China)

机构地区：[1]北京中医药大学东直门医院,北京100010

出　　处：《中国骨伤》2023年第1期79-85,共7页China Journal of Orthopaedics and Traumatology

基　　金：北京市自然科学基金项目(编号:L192059)。

摘　　要：目的:探讨痉挛型脑瘫患儿粗大运动功能分级(gross motor function classification system,GMFCS)与髋关节、腰椎发育的关系。方法:回顾性分析2018年1月至2021年7月收治的125例痉挛型脑瘫患儿,男85例,女40例,年龄4~12(8.4±2.9)岁。依据GMFCS分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级组。其中Ⅰ级组27例,Ⅱ级组40例,Ⅲ级组35例,Ⅳ级组23例。通过骨盆正位X线片,测量股骨头偏移百分比(migration percentage,MP)、中心边缘角(central edge angle,CE),颈干角(neck-shaft angle,NSA)、髋臼指数(acetabular index,AI),并选取其严重侧髋关节参数值分析,评价不同GMFCS分级与髋关节发育的关系。通过腰椎侧位X线片,测量腰椎矢状位Cobb角、腰骶角、腰椎前凸指数、弓顶距,评价不同GMFCS分级与腰椎发育的关系。结果:(1)119例痉挛型脑瘫患儿的骨盆正位X线片符合测量标准。Ⅰ-Ⅳ级4组MP分别为(22.72±3.88)、(26.53±4.36)、(33.84±4.99)、(49.54±7.87)%,两两比较差异均有统计学意义(P<0.05);4组CE分别为(30.10±6.99)°、(22.92±4.19)°、(17.91±5.50)°、(-0.70±17.33)°,两两比较差异均有统计学意义(P<0.05);4组AI分别为(16.41±2.77)°、(20.46±4.63)°、(23.76±5.10)°、(29.15±7.35)°,两两比较差异均有统计学意义(P<0.05);且GMFCS分级越高,MP和AI越大,CE越小。Ⅰ-Ⅳ级4组NSA分别为(142.74±10.03)°、(148.66±9.09)°、(151.66±10.52)°、(153.70±8.05)°,GMFCSⅠ级组与其余3组两两比较差异均有统计学意义(P<0.05),GMFCSⅠ级组NSA明显低于其他3组,其余组间两两比较差异均无统计学意义(P>0.05)。(2)88例痉挛型患儿的腰椎侧位X线片符合测量标准。Ⅰ-Ⅳ级4组腰椎矢状位Cobb角分别为(32.62±11.10)°、(29.86±9.90)°、(31.70±11.84)°、(39.69±6.80)°,GMFCSⅣ级腰椎矢状位Cobb角明显高于其余3组,两两比较差异均有统计学意义(P<0.05)。其余各组间两两比较差异均无统计学意义(P>0.05);4组腰骶角分别为(31.02±9.91)°、(26.57±9.41)°、Objective To investigate the relationship among the gross motor function classification system(GMFCS)and the development of hip joint and lumbar spine in children with spastic cerebral palsy.Methods The clinical data of 125 children with spastic cerebral palsy admitted from January 2018 to July 2021 were retrospectively analyzed.There were 85 males and 40 females,aged from 4 to 12 years old with an average of(8.4±2.9)years.According to GMFCS,the patients were divided into gradeⅠ,Ⅱ,ⅢandⅣgroups.There were 27 cases in gradeⅠgroup,40 cases in gradeⅡgroup,35 cases in gradeⅢgroup and 23 cases in gradeⅣgroup.The migration percentage(MP),central edge angle(CE),neck-shaft angle(NSA),acetabular index(AI)were measured by the radiograph of pelvis,abnormal parameters were selected to evaluate the relationship between different GMFCS grades and hip joint development.Lumbar sagittal Cobb angle,lumbar sacral angle,lumbar lordosis index and apical distance were measured by lateral lumbar radiographs to evaluate the relationship between different GMFCS grades and lumbar spine development.Results①Among the 125 spastic cerebral palsy children,there were 119 cases of pelvic radiographs that met the measurement standards.In the four groups with gradeⅠ,Ⅱ,Ⅲ,Ⅳ,MP was(22.72±3.88),(26.53±4.36),(33.84±4.99),and(49.54±7.87)%,CE was(30.10±6.99)°,(22.92±4.19)°,(17.91±5.50)°,and(-0.70±17.33)°,AI was(16.41±2.77)°,(20.46±4.63)°,(23.76±5.10)°,and(29.15±7.35)°,respectively,there were significant differences between the two comparisons(P<0.05).And the higher GMFCS grade,the greater MP and AI,and the smaller CE.The NSA was(142.74±10.03)°,(148.66±9.09)°,(151.66±10.52)°,and(153.70±8.05)°in four groups with gradeⅠ,Ⅱ,Ⅲ,Ⅳ,respectively.The differences between the two comparisons of the GMFCS gradeⅠgroup and the other three groups were statistically significant(P<0.05).NSA of GMFCSⅠgroup was significantly lower than that of the others,there was no significant difference among other groups(P>

关 键 词：脑性瘫痪 粗大运动功能分级 髋脱位 腰椎前凸 

分 类 号：R682.6[医药卫生—骨科学]