颅缝早闭合并神经发育障碍患儿手术后康复干预效果的影响因素分析  

Analysis of influencing factors for postoperative neurological functional outcomes in children with craniosynostosis and neurodevelopmental disorders

作　　者：段雅琴 吴水华 胡继红 刘娟[1] 刘华 Duan Yaqin;Wu Shuihua;Hu Jihong;Liu Juan;Liu Hua(Department of Rehabilitation Medicine,The Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China;Department of Neurosurgery,The Affiliated Children’s Hospital of Xiangya School of Medicine,Central South University(Hunan Children’s Hospital),Changsha 410007,China)

机构地区：[1]中南大学湘雅医学院附属儿童医院湖南省儿童医院康复中心,长沙410007 [2]中南大学湘雅医学院附属儿童医院湖南省儿童医院神经外科,长沙410007

出　　处：《临床小儿外科杂志》2025年第2期179-183,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省残疾人康复科研项目(2021XK0221);湖南省科技厅临床医学研究中心项目(2021SK4018);湖南省自然科学基金资助项目(2025JJ50682)。

摘　　要：目的探讨颅缝早闭(craniosynostosis,CS)合并神经发育障碍患儿手术后康复干预效果的影响因素。方法回顾性分析2016年9月至2023年3月于湖南省儿童医院接受手术治疗并行手术后康复干预的颅缝早闭合并神经发育障碍患儿临床资料。根据手术后首次及末次随访时格赛尔发育诊断量表(gesell developmental schedule,GDS)中发育商(developmental quotient,DQ)评分差值,评价CS合并神经发育障碍患儿手术后康复干预效果及其影响因素。将随访末次与首次GDS的DQ评分差值≥10分者归为效果良好组,DQ差值<10分者归为效果欠佳组。收集两组患儿性别、手术年龄、CS类型、主要带养者学历、术后首次及末次GDS评估年龄、康复干预起始年龄、康复干预总时长以及随访时长等,分析CS合并神经发育障碍患儿手术后康复干预效果的影响因素。结果本研究共纳入41例颅缝早闭合并神经发育障碍患儿,其中效果欠佳组14例,效果良好组27例。单因素分析发现,两组术后首次DQ值[44.50(18.75,62.25)比69.00(62.00,78.00),Z=-3.259,P=0.001]、康复干预起始年龄[(28.00(17.5,36.75)个月比14.00(9.00,18.00)个月,Z=-3.358,P=0.000]、康复干预总时长[(7.500(2.50,12.75)个月比14.00(12.00,18.00)个月,Z=-2.604,P=0.008],差异均具有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术后首次DQ值(OR=1.140,95%CI:1.044~1.246)、康复干预起始年龄(OR=0.919,95%CI:0.849~0.996)、康复干预总时长(OR=1.314,95%CI:1.016~1.698)是CS合并神经发育障碍患儿手术后康复效果的独立影响因素。根据cut-off值将患儿分组为术后首次DQ≥52.5分组与<52.5分组、康复干预总时长≥9.5个月组与<9.5个月组、康复干预起始年龄≥22.5个月组与<22.5个月组,各分组患儿DQ差值比较,差异均具有统计学意义(P<0.05)。结论术后首次DQ评分≥52.5分较<52.5分,康复干预总时长≥9.5个月较<9.5个月,康复干预起始年龄≥22.5个月�Objective To explore the influencing factors for the effectiveness of postoperative rehabilitative interventions in children with craniosynostosis(CS)plus neurodevelopmental disorders.Methods Retrospective analysis was conducted for the relevant clinical data of 41 CS children plus neurodevelopmental disorders undergoing postoperative rehabilitative interventions from September 2016 to March 2023.The influencing factors for the effectiveness of postoperative rehabilitative interventions were evaluated based upon the differential scores of developmental quotient(DQ)from the first and last assessments using Gesell Developmental Schedule(GDS).They were classified into a"good efficacy group"(n=27)if DQ score difference between the first and last GDS assessments was≥10 points and a"poor efficacy group"(n=14)if DQ score difference<10 points.The relevant data collected for both groups included gender,age at surgery,type of CS,education level of primary caregivers,first and last GDS DQ scores,assessment age,age at the start of rehabilitative intervention,total duration of rehabilitation and follow-up time.The influencing factors for postoperative rehabilitation were then examined.Results Univariate analysis of two groups revealed statistically significant differences in postoperative first DQ score[44.50(18.75,62.25)vs.69.00(62.00,78.00),Z=-3.259,P=0.001],age at the start of rehabilitative intervention[28.00(17.5,36.75)vs.14.00(9.00,18.00)month,Z=-3.358,P=0.000]and total duration of rehabilitation[7.500(2.50,12.75)vs.14.00(12.00,18.00)month,Z=-2.604,P=0.008](P<0.05).These variables were then included in multivariate Logistic regression analysis.The results indicated that postoperative first DQ score(OR=1.140,95%CI:1.044-1.246),age at the start of rehabilitative intervention(OR=0.919,95%CI:0.849-0.996)and total rehabilitative duration(OR=1.314,95%CI:1.016-1.698)were independent influencing factors for the effectiveness of postoperative rehabilitation.Based upon the cut-off values,comparisons of DQ score differences were

关 键 词：颅缝早闭 康复干预 神经发育障碍 影响因素 

分 类 号：R726.5[医药卫生—儿科]