目的 探讨婴儿体位性斜头异常对体格生长和神经发育的影响。 方法 回顾性研究2018年6月—2022年5月在北京大学第三医院进行颅形检测并随访至3岁的467例儿童的临床资料。根据斜头程度,分为轻度斜头异常组(108例)、中度斜头异常组(49例)、重度斜头异常组(12例)和正常颅形组(298例)。比较4组的一般资料及6~36月龄的体重、身长、头围、视力筛查结果、听力检查结果、小儿神经心理发育量表评分/格塞尔发育量表评分。 结果 轻、中、重度斜头异常组具有不良围生期因素患儿比例及先天性肌性斜颈和仰卧位固定睡姿的患儿比例均高于正常颅形组,差异有统计学意义(P<0.05)。轻、中、重度斜头异常组和正常颅形组6月龄、12月龄、24月龄、36月龄的体重、身长、头围的比较差异均无统计学意义(P>0.05)。24月龄和36月龄时重度斜头异常组的视力异常发生率高于轻度斜头异常组、中度斜头异常组和正常颅形组,差异有统计学意义(P<0.05)。重度斜头异常组在12月龄和24月龄的小儿神经心理发育量表评分和36月龄的格塞尔发育量表评分均低于轻度斜头异常组、中度斜头异常组和正常颅形组,但差异无统计学意义(P>0.05)。 结论 不良围生期因素、先天性肌性斜颈、仰卧位固定睡姿与婴儿体位性斜头异常可能有关联。轻、中度体位性斜头异常对患儿的生长和神经发育无明显影响,重度体位性斜头异常对视力有不良影响,但尚不能认为重度体位性斜头异常会影响患儿的神经发育。 [中国当代儿科杂志,2023,25(4):368-373]
Abstract
Objective To study the effects of infantile positional plagiocephaly on the growth and neural development. Methods A retrospective study was conducted on the medical data of 467 children who underwent craniographic examination and were followed up to 3 years of age in Peking University Third Hospital from June 2018 to May 2022. They were divided into four groups: mild positional plagiocephaly (n=108), moderate positional plagiocephaly (n=49), severe positional plagiocephaly (n=12), and normal cranial shape (n=298). The general information of the four groups and the weight, length, head circumference, visual acuity screening results, hearing test results, and the scores of Pediatric Neuropsychological Developmental Scales/Gesell Developmental Schedules of the four groups from 6 to 36 months old were compared. Results The rates of adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping posture in the mild, moderate, and severe positional plagiocephaly groups were higher than the normal cranial group (P<0.05). There was no significant difference in weight, length, and head circumference among the four groups at 6, 12, 24 and 36 months of age (P>0.05). The incidence rate of abnormal vision in the severe positional plagiocephaly group was higher than that in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups at 24 and 36 months of age (P<0.05). The scores of the Pediatric Neuropsychological Developmental Scales at 12 and 24 months of age and the scores of the Gesell Developmental Schedules at 36 months of age in the severe positional plagiocephaly group were lower than those in the mild positional plagiocephaly, moderate positional plagiocephaly and normal cranial shape groups, but the difference was not statistically significant (P>0.05). Conclusions Adverse perinatal factors, congenital muscular torticollis, and supine fixed sleeping position may be associated with infantile positional plagiocephaly. Mild or moderate positional plagiocephaly has no significant impact on the growth and neural development of children. Severe positional plagiocephaly have adverse effects on the visual acuity. However, it is not considered that severe positional plagiocephaly can affect the neurological development. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(4): 368-373
关键词
体位性斜头异常 /
神经发育 /
体格生长 /
预后 /
儿童
Key words
Positional plagiocephaly /
Neurodevelopment /
Physical growth /
Prognosis /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 Aihara Y, Komatsu K, Dairoku H, et al. Cranial molding helmet therapy and establishment of practical criteria for management in Asian infant positional head deformity[J]. Childs Nerv Syst, 2014, 30(9): 1499-1509. PMID: 24965682. DOI: 10.1007/s00381-014-2471-y.
2 Bennis Y, Wolber A, Vinchon M, et al. Non syndromic craniosynostosis[J]. Ann Chir Plast Esthet, 2016, 61(5): 389-407. PMID: 27499256. DOI: 10.1016/j.anplas.2016.07.004.
3 Jung BK, Yun IS. Diagnosis and treatment of positional plagiocephaly[J]. Arch Craniofac Surg, 2020, 21(2): 80-86. PMID: 32380806. PMCID: PMC7206465. DOI: 10.7181/acfs.2020.00059.
4 D?rhage KWW, Wiltfang J, von Grabe V, et al. Effect of head orthoses on skull deformities in positional plagiocephaly: evaluation of a 3-dimensional approach[J]. J Craniomaxillofac Surg, 2018, 46(6): 953-957. PMID: 29680682. DOI: 10.1016/j.jcms.2018.03.013.
5 Lipira AB, Gordon S, Darvann TA, et al. Helmet versus active repositioning for plagiocephaly: a three-dimensional analysis[J]. Pediatrics, 2010, 126(4): e936-e945. PMID: 20837585. DOI: 10.1542/peds.2009-1249.
6 Collett BR, Aylward EH, Berg J, et al. Brain volume and shape in infants with deformational plagiocephaly[J]. Childs Nerv Syst, 2012, 28(7): 1083-1090. PMID: 22447491. PMCID: PMC3393042. DOI: 10.1007/s00381-012-1731-y.
7 Holowka MA, Reisner A, Giavedoni B, et al. Plagiocephaly severity scale to aid in clinical treatment recommendations[J]. J Craniofac Surg, 2017, 28(3): 717-722. PMID: 28468155. DOI: 10.1097/SCS.0000000000003520.
8 Miyabayashi H, Nagano N, Kato R, et al. Cranial shape in infants aged one month can predict the severity of deformational plagiocephaly at the age of six months[J]. 2022, 11(7): 1797. PMID: 35407405. PMCID: PMC8999343. DOI: 10.3390/jcm11071797.
9 杨玉凤. 儿童发育行为心理评定量表[M]. 北京: 人民卫生出版社, 2016: 135-150.
10 杨玉凤. 儿童发育行为心理评定量表[M]. 北京: 人民卫生出版社, 2016: 161-175.
11 Kreppel M, Kauke M, Safi AF, et al. Clinical evaluation of non-syndromic scaphocephaly surgically corrected with the procedure of total vertex craniectomy[J]. J Craniomaxillofac Surg, 2018, 46(9): 1465-1469. PMID: 29960814. DOI: 10.1016/j.jcms.2018.05.057.
12 Captier G, Galeron A, Subsol G, et al. Cerebrospinal fluid volume does not have etiological role in the incidence of positional skull deformities[J]. J Craniomaxillofac Surg, 2017, 45(9): 1387-1393. PMID: 28687466. DOI: 10.1016/j.jcms.2017.06.005.
13 Nuysink J, Eijsermans MJ, van Haastert IC, et al. Clinical course of asymmetric motor performance and deformational plagiocephaly in very preterm infants[J]. J Pediatr, 2013, 163(3): 658-665.e1. PMID: 23706356. DOI: 10.1016/j.jpeds.2013.04.015.
14 de Ribaupierre S, Vernet O, Rilliet B, et al. Posterior positional plagiocephaly treated with cranial remodeling orthosis[J]. Swiss Med Wkly, 2007, 137(25-26): 368-372. PMID: 17629800. DOI: 10.4414/smw.2007.11702.
15 Kuo AA, Tritasavit S, Graham JM. Congenital muscular torticollis and positional plagiocephaly[J]. Pediatr Rev, 2014, 35(2): 79-87. PMID: 24488831. DOI: 10.1542/pir.35-2-79.
16 Fowler EA, Becker DB, Pilgram TK, et al. Neurologic findings in infants with deformational plagiocephaly[J]. J Child Neurol, 2008, 23(7): 742-747. PMID: 18344457. DOI: 10.1177/0883073808314362.
17 Jung BK, Yun IS. Diagnosis and treatment of positional plagiocephaly [J]. Arch Craniofac Surg, 2020, 21(2): 80-86. PMID: 32380806. PMCID: PMC7206465. DOI: 10.7181/acfs.2020.00059.
18 潘维伟, 童笑梅. 101例婴儿斜头异常的临床分析[J]. 中国当代儿科杂志, 2017, 19(10): 1061-1065. PMID: 29046201. PMCID: PMC7389278. DOI: 10.7499/j.issn.1008-8830.2017.10.006.
19 Han MH, Kang JY, Han HY, et al. Relationship between starting age of cranial-remolding-orthosis therapy and effectiveness of treatment in children with deformational plagiocephaly[J]. Childs Nerv Syst, 2017, 33(8): 1349-1356. PMID: 28484866. DOI: 10.1007/s00381-017-3427-9.
20 Hutchison L. Deformational plagiocephaly is associated with developmental delay in toddlers[J]. J Pediatr, 2012, 160(3): 527-528. PMID: 22329877. DOI: 10.1016/j.jpeds.2012.01.005.
21 Collett BR, Starr JR, Kartin D, et al. Development in toddlers with and without deformational plagiocephaly[J]. Arch Pediatr Adolesc Med, 2011, 165(7): 653-658. PMID: 21727278. PMCID: PMC3393044. DOI: 10.1001/archpediatrics.2011.92.
22 Zhao XQ, Wang LY, Zhao CM, et al. Neurological assessment of Chinese infants with positional plagiocephaly using a Chinese version of the Infant Neurological International Battery (INFANIB)[J]. Childs Nerv Syst, 2017, 33(2): 281-288. PMID: 27718070. DOI: 10.1007/s00381-016-3260-6.