华西医学

华西医学

先天性肌性斜颈患儿早期运动发育状况及相关危险因素分析

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目的 考察 0~3 个月龄的先天性肌性斜颈(congenital muscular torticollis,CMT)患儿的运动发育状况和影响运动发育的危险因素,为关注和预防运动发育落后提供依据。 方法 对 2016 年 1 月 1 日—2018 年 4 月 30 日在上海交通大学医学院附属新华医院康复医学科就诊的 CMT 患儿进行 Alberta 婴儿运动量表(Alberta Infant Motor Scale,AIMS)评估,并收集患儿的出生体重、出生身长、出生方式、睡眠姿势、清醒时俯卧位时间等变量,与同龄健康婴儿的 AIMS 评估结果和变量对比,分析变量与 AIMS 得分的相关关系。 结果 CMT 组 97 例,男 62 例,女 35 例,评估月龄(46.8±17.3)d,出生体重(3.34±0.38)kg,出生身长(49.56±0.93)cm;对照组 97 例,男 60 例,女 37 例,评估月龄(45.1±19.4)d,出生体重(3.38±0.35)kg,出生身长(49.84±1.03)cm;两组性别、月龄、出生身长和体重比较差异均无统计学意义(P>0.05)。AIMS 评估显示,CMT 组中有 37.1%(36 例)的婴儿为可疑或异常运动发育,而对照组仅有 12.4%(12 例),两组差异有统计学意义(χ2=15.945,P<0.001);多重线性回归分析显示,清醒时俯卧位时间和 CMT 对 AIMS 评估结果存在影响(F=64.851,P<0.001),清醒时俯卧位时间的增加会提高 AIMS 评分结果而 CMT 会降低 AIMS 评分结果,其他变量与 AIMS 无相关关系。 结论 0~3 个月的 CMT 患儿发生早期运动发育落后的风险高于同龄健康婴儿,清醒时俯卧位时间减少和 CMT 可能是其发生运动发育延迟的原因,临床医务人员和家庭照顾者应当提高对 CMT 运动发育情况的重视并提供合理的干预。

Objective To investigate the early motor development and the risk factors affecting motor development in children with congenital muscular torticollis (CMT) aged 0–3 months. Methods CMT infants admitting to the Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine between January 1st, 2016 and April 30th, 2018 were enrolled as CMT group, and contemporaneous age-matched healthy infants were enrolled as the control group. Motor development was assessed with the Alberta Infant Motor scale (AIMS). We collected the birth weight, birth length, mode of birth, sleep position, and prone time when awake as dependent variables, and used multiple linear regression to find the variables that had significant effect on AIMS scores. Results There were 97 CMT infants (62 males and 35 females) with the mean age of (46.8±17.3) days, mean birth weight of (3.34±0.38) kg and mean birth length of (49.56±0.93) cm in the CMT group, while there were 97 healthy infants (60 males and 37 females) with the mean age of (45.1±19.4) days, mean birth weight of (3.38±0.35) kg and mean birth length of (49.84±1.03) cm in the control group, and the differences in sex, age, birth weight, birth length between the two groups were not statistically significant (P>0.05). AIMS centiles showed that 36 infants (37.1%) in CMT group had suspicious or abnormal motor development, while only 12 infants (12.4%) in the control group had; there was a significant statistical difference between the two groups (χ2=15.945, P<0.001). Multiple linear regression analysis showed that the time of prone position when awake and CMT had significant influence on the AIMS scores (F=64.851, P<0.001). Infants who had a long prone position when awake had significantly higher AIMS scores and CMT had a significantly lower AIMS scores (P<0.001). Conclusions The risk of early motor retardation in infants with CMT aged 0–3 months is higher than that in healthy infants of the same age. The decrease in prone position when awake and CMT may be the causes of delayed motor development. Clinical medical personnel and family caregivers should pay more attention to motor development and provide reasonable intervention to CMT infants.

关键词: 先天性肌性斜颈; Alberta 婴儿运动量表; 俯卧位

Key words: Congenital muscular torticollis; Alberta Infant Motor Scale; Prone position

引用本文: 陈楠, 杜青, 陈晨, 顾文娟, 范擎松, 杨宇琪, 邓巍巍, 李欣, 梁菊萍. 先天性肌性斜颈患儿早期运动发育状况及相关危险因素分析. 华西医学, 2018, 33(10): 1257-1261. doi: 10.7507/1002-0179.201805171 复制

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1. Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association. Pediatr Phys Ther, 2013, 25(4): 348-394.
2. Cheng JC, Tang SP, Chen TM. Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases. J Pediatr, 1999, 134(6): 712-716.
3. 杜青, 陈珽, 沈品泉, 等. 先天性肌性斜颈早期康复治疗的疗效探讨. 中华物理医学与康复杂志, 2005, 27(6): 370-372.
4. 王晓慧. 先天性肌性斜颈的物理治疗效果分析. 中华物理医学与康复杂志, 2001, 23(3): 189-190.
5. Celayir AC. Congenital muscular torticollis: early and intensive treatment is critical. A prospective study. Pediatr Int, 2000, 42(5): 504-507.
6. Cheng JC, Wong MW, Tang SP, et al. Clinical determinants of the outcome of manual stretching in the treatment of congenital muscular torticollis in infants. A prospective study of eight hundred and twenty-one cases. J Bone Joint Surg Am, 2001, 83-A(5): 679-687.
7. van Vlimmeren LA, Helders PJ, van Adrichem LN, et al. Torticollis and plagiocephaly in infancy: therapeutic strategies. Pediatr Rehabil, 2006, 9(1): 40-46.
8. Schertz M, Zuk L, Zin S, et al. Motor and cognitive development at one-year follow-up in infants with torticollis. Early Hum Dev, 2008, 84(1): 9-14.
9. Öhman A, Nilsson S, Lagerkvist AL, et al. Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants?. Dev Med Child Neurol, 2009, 51(7): 545-550.
10. Hurran C. Motor assessment of the developing infant. Physiotherapy, 1995, 81(4): 244.
11. 余静, 何晓芸, 谢坚, 等. 绵阳市城区 255 名 0~12 月婴儿体格发育调查. 华西医学, 2006, 21(3): 528-529.
12. Piper MC, Darrah J. 发育中婴儿的运动评估. 黄真, 李明, 译. 北京: 北京大学医学出版社, 2009.
13. Darrah J, Piper M, Watt MJ. Assessment of gross motor skills of at-risk infants: predictive validity of the Alberta Infant Motor Scale. Dev Med Child Neurol, 1998, 40(7): 485-491.
14. Schertz M, Zuk L, Green D. Long-term neurodevelopmental follow-up of children with congenital muscular torticollis. J Child Neurol, 2013, 28(10): 1215-1221.
15. Cabrera-Martos I, Valenza MC, Benítez-Feliponi A, et al. Clinical profile and evolution of infants with deformational plagiocephaly included in a conservative treatment program. Childs Nerv Syst, 2013, 29(10): 1893-1898.
16. Mcgraw MB. The neuromuscular maturation of the human infant. J Nerv Ment Dis, 1944, 99(3): 470.
17. Smith LB, Samuelson LK. Different is good: connectionism and dynamic systems theory are complementary emergentist approaches to development. Dev Sci, 2003, 6(4): 434-439.
18. 王翠, 黄真. Alberta 婴儿运动量表. 中国康复医学杂志, 2009, 24(9): 858-861.
19. Mildred J, Beard K, Dallwitz A, et al. Play position is influenced by knowledge of SIDS sleep position recommendations. J Paediatr Child Health, 1995, 31(6): 499-502.
20. Pin T, Eldridge B, Galea MP. A review of the effects of sleep position, play position, and equipment use on motor development in infants. Dev Med Child Neurol, 2007, 49(11): 858-867.
21. Markestad T, Skadberg B, Hordvik E, et al. Sleeping position and sudden infant death syndrome (SIDS): effect of an intervention programme to avoid prone sleeping. Acta Paediatr, 1995, 84(4): 375-378.