兒童生長痛的流行病學(xué)調(diào)查及與相關(guān)因素的分析
發(fā)布時(shí)間：2018-08-27 08:05
【摘要】：目的：生長痛(Growing pains, GP)是一種原因不明、發(fā)生在小兒生長最旺盛期之前的一種肢體痛癥,臨床上十分常見,但容易被醫(yī)生漏診和誤診,確切的發(fā)生機(jī)制仍不明確,至今也沒有滿意的治療方法。本課題通過對長沙市3～7歲兒童生長痛的流行病現(xiàn)況研究,危險(xiǎn)因素的病例對照研究,生長痛與下肢力線參數(shù)的相關(guān)性分析及長沙市生長痛兒童下肢肌肉表面肌電信號(hào)的病例對照研究。探討生長痛的發(fā)生機(jī)制,以期為臨床工作提供相應(yīng)的參考依據(jù)。方法：1.2014年5月至2014年6月以年齡在3-7歲之間的幼兒及低年級(jí)小學(xué)生為調(diào)查對象,選取長沙市2所幼兒園與1所小學(xué)共1600名兒童。采用自行設(shè)計(jì)的《3-7歲兒童下肢生長痛情況調(diào)查問卷》實(shí)施橫斷面調(diào)查。在校方的認(rèn)可及支持下,統(tǒng)一發(fā)放調(diào)查表,調(diào)查表于2天后由班主任統(tǒng)一收回。調(diào)查員現(xiàn)場測量研究兒童的下肢力線參數(shù)。剔除無效問卷后,對結(jié)果進(jìn)行數(shù)據(jù)整理與統(tǒng)計(jì)分析。2.將2014年5月～10月期間在我院小兒骨科門診就診且診斷為生長痛伴旋前足的3～7歲兒童按抽樣法隨機(jī)選取48名兒童為病例組,同時(shí)確定非生長痛的48名對照組兒童,采用表面肌電測試系統(tǒng),檢測得出站立位、提踵位時(shí)所測試雙側(cè)脛骨前肌、腓骨長肌、脛骨后肌、腓腸肌的均方根值(Root mean square, RMS值)。對結(jié)果進(jìn)行數(shù)據(jù)整理與統(tǒng)計(jì)分析。結(jié)果：1.現(xiàn)況調(diào)查結(jié)果顯示：①長沙市3～7歲兒童生長痛的發(fā)生率為15.2%；②男女兒童之間GP發(fā)生的頻率差異有統(tǒng)計(jì)學(xué)意義(P=0.003)；男女兒童之間GP發(fā)生的性質(zhì)間差異有統(tǒng)計(jì)學(xué)意義(P=0.001)；男女兒童之間的GP持續(xù)時(shí)間的差異沒有統(tǒng)計(jì)學(xué)意義(P=0.187)；③25.8%的GP患兒因?yàn)樘弁从卺t(yī)療機(jī)構(gòu)就診過。男孩因?yàn)镚P去醫(yī)院就診的比例高于女孩(P=0.006)。2.(1)危險(xiǎn)因素的病例對照研究單因素分析結(jié)果顯示：①病例組中46.7%有家族史,對照組中25.8%,兩者比較差異有統(tǒng)計(jì)學(xué)意義；②病例組兒童開展球類運(yùn)動(dòng)的比例高于對照組,兩組間差異有統(tǒng)計(jì)學(xué)意義(P=0.043)；③病例組兒童開展舞蹈項(xiàng)目的比例高于對照組,兩組間差異有統(tǒng)計(jì)學(xué)意義(P=0.022)；④病例組兒童開展體操運(yùn)動(dòng)的比例高于對照組,兩組間差異有統(tǒng)計(jì)學(xué)意義(P=0.018)；⑤對照組中正常步態(tài)的比例高于病例組,差異有統(tǒng)計(jì)學(xué)意義(P=0.034)；⑥病例組兒童每次進(jìn)行體育活動(dòng)的時(shí)間多于對照組,兩組的差異有統(tǒng)計(jì)學(xué)意義(P=0.001)；⑦病例組兒童運(yùn)動(dòng)后疲勞程度較對照組高,兩組的差異有統(tǒng)計(jì)學(xué)意義(P=0.001)；⑧病例組兒童挑食的比例高于對照組,兩組間差異有統(tǒng)計(jì)學(xué)意義,(P=0.027)。2.(2)多因素非條件Logistic回歸分析研究結(jié)果顯示：①家族史是GP的危險(xiǎn)因素(OR=2.116)；②兒童挑食是GP的危險(xiǎn)因素(OR=2.745)；③兒童開展球類運(yùn)動(dòng)是GP的危險(xiǎn)因素(OR=1.279)；④體操運(yùn)動(dòng)是GP的危險(xiǎn)因素,(OR=2.354)。⑤正常步態(tài)是GP的保護(hù)因素(OR=0.854)。3.兒童生長痛與下肢力線參數(shù)的相關(guān)性分析結(jié)果顯示：①GP與非GP兩組兒童的下肢力線差異有統(tǒng)計(jì)學(xué)意義(P=0.027)。②GP與非GP兩組兒童的下肢扭轉(zhuǎn)差異有統(tǒng)計(jì)學(xué)意義(P=0.041)。③GP與非GP兩組兒童的足部姿態(tài)差異有統(tǒng)計(jì)學(xué)意義(P=0.019)。④GP與非GP兩組兒童的關(guān)節(jié)松弛差異有統(tǒng)計(jì)學(xué)意義(P=0.017)。4.兒童下肢肌肉表面肌電信號(hào)研究顯示：①站立位旋前足GP患兒腓骨長肌肌電活動(dòng)水平增加(P=0.004)；②提踵位旋前足GP患兒腓腸肌肌電活動(dòng)減少(P=0.04),脛骨后肌肌電活動(dòng)增加(P=0.001)。③當(dāng)GP兒童足部力線異常時(shí),肌肉活動(dòng)的改變可能導(dǎo)致GP的發(fā)生。結(jié)論：第一部分：GP是長沙市3～7歲兒童的一種常見病痛。GP發(fā)生的頻率、疼痛的性質(zhì)、就診的情況以及GP對正常生活的影響等與性別有關(guān)系。第二部分：GP可能存在遺傳因素。兒童過早開始球類運(yùn)動(dòng)及體操可能導(dǎo)致GP的發(fā)生,而且每次進(jìn)行體育活動(dòng)的時(shí)間長短、運(yùn)動(dòng)后疲勞程度與GP有關(guān)。兒童步態(tài)異常、挑食是GP的危險(xiǎn)因素。第三部分：兒童GP的發(fā)生與下肢力線差異、下肢扭轉(zhuǎn)差異、足部姿態(tài)差異、關(guān)節(jié)松弛有關(guān)。第四部分：GP伴旋前足兒童在站立位時(shí)腓骨長肌的肌電活動(dòng)水平出現(xiàn)增加；在提踵位時(shí)旋前足的腓腸肌肌電活動(dòng)出現(xiàn)減少,脛骨后肌的肌電活動(dòng)增加；足部力線異常時(shí),肌肉活動(dòng)的改變可能是導(dǎo)致GP發(fā)生的原因。
[Abstract]:Objective: Growing pains (GP) is a kind of limb pain which occurs before the most vigorous growth period of children. It is very common in clinic, but it is easy to be missed and misdiagnosed by doctors. The exact pathogenesis is still unclear, and there is no satisfactory treatment for it. Epidemiological study, case-control study on risk factors, correlation between growth pain and lower limb force line parameters, and case-control study on lower limb muscle surface electromyogram (EMG) signals of children with growth pain in Changsha City were carried out. The occurrence mechanism of growth pain was discussed in order to provide reference for clinical work. A cross-sectional survey was conducted in 2 kindergartens and 1 600 primary school children aged 3-7 years in Changsha. A self-designed questionnaire was used to investigate the growth pain of the lower limbs of children aged 3-7 years. With the approval and support of the school, the questionnaire was distributed uniformly and the questionnaire was sent to the class after 2 days. Investigators measured the parameters of the children's lower limb force line on the spot. After eliminating the invalid questionnaires, the data were sorted out and analyzed statistically. 2. 48 children aged 3-7 with growth pain and pronation foot were randomly selected as the case group according to the sampling method. The root mean square (RMS) values of bilateral anterior tibial muscle, peroneus longus, posterior tibial muscle and gastrocnemius muscle were measured in the levator position. The data were sorted out and analyzed statistically. Results: 1. (1) The incidence of growth pain in children aged 3 to 7 years in Changsha was 15.2%; the frequency of GP was significantly different between boys and girls (P = 0.003); the nature of GP was significantly different between boys and girls (P = 0.001); the difference of GP duration between boys and girls was not statistically significant (P = 0.187); and (3) the frequency of GP was significantly different between boys and girls (P = 0.003); The proportion of boys going to hospital because of GP was higher than that of girls (P = 0.006). 2. (1) The univariate analysis of risk factors showed that: (1) 46.7% of the children in the case group had family history and 25.8% of the children in the control group had ball games, the difference was statistically significant; The proportion of children in the case group was higher than that in the control group (P = 0.043), the proportion of children in the case group was higher than that in the control group (P = 0.022), and the proportion of children in the case group was higher than that in the control group (P = 0.018). The proportion of normal gait was higher than that of the case group, and the difference was statistically significant (P = 0.034). _The time of physical activity in the case group was longer than that in the control group, and the difference was statistically significant (P = 0.001). _The degree of fatigue in the case group was higher than that in the control group, and the difference between the two groups was statistically significant (P = 0.001). The proportion of children picking food was higher than that of the control group, and the difference was statistically significant between the two groups (P = 0.027). 2. Multivariate unconditional logistic regression analysis showed that: (1) Family history was a risk factor for GP (OR = 2.116);; (2) picking food was a risk factor for GP (OR = 2.745); and (3) ball games were a risk factor for GP (OR = 1.279). (4) Gymnastics is a risk factor for GP. (OR = 2.354). _Normal gait is a protective factor for GP. (OR = 0.854). 3. Correlation analysis between growth pain and lower limb force line parameters showed that: (1) There was significant difference in lower limb force line between GP and non-GP groups (P = 0.027). 2) There was significant difference in lower limb torsion between GP and non-GP groups. (P = 0.041). There was a significant difference in foot posture between GP and non-GP groups (P = 0.019). There was a significant difference in joint relaxation between GP and non-GP groups (P = 0.017). 4. The EMG signal of lower limb muscle surface in children showed that: (1) the electromyographic activity of peroneus longus muscle in GP patients with standing pronation increased (P = 0.004); The gastrocnemius myoelectric activity decreased (P = 0.04) and the posterior tibial myoelectric activity increased (P = 0.001) in GP children with heel pronation. The second part: GP may have genetic factors. Early start of ball games and gymnastics in children may lead to the occurrence of GP, and the duration of each physical activity, the degree of fatigue after exercise is related to GP. Part 4: The electromyographic activity of the longus peroneus increased in children with GP in standing position, the electromyographic activity of the gastrocnemius decreased and the electromyographic activity of the posterior tibial muscle increased in elevating heel position. Changes in muscle activity may be responsible for the occurrence of GP when the foot line is abnormal.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R179
本文編號(hào)：2206630
[Abstract]:Objective: Growing pains (GP) is a kind of limb pain which occurs before the most vigorous growth period of children. It is very common in clinic, but it is easy to be missed and misdiagnosed by doctors. The exact pathogenesis is still unclear, and there is no satisfactory treatment for it. Epidemiological study, case-control study on risk factors, correlation between growth pain and lower limb force line parameters, and case-control study on lower limb muscle surface electromyogram (EMG) signals of children with growth pain in Changsha City were carried out. The occurrence mechanism of growth pain was discussed in order to provide reference for clinical work. A cross-sectional survey was conducted in 2 kindergartens and 1 600 primary school children aged 3-7 years in Changsha. A self-designed questionnaire was used to investigate the growth pain of the lower limbs of children aged 3-7 years. With the approval and support of the school, the questionnaire was distributed uniformly and the questionnaire was sent to the class after 2 days. Investigators measured the parameters of the children's lower limb force line on the spot. After eliminating the invalid questionnaires, the data were sorted out and analyzed statistically. 2. 48 children aged 3-7 with growth pain and pronation foot were randomly selected as the case group according to the sampling method. The root mean square (RMS) values of bilateral anterior tibial muscle, peroneus longus, posterior tibial muscle and gastrocnemius muscle were measured in the levator position. The data were sorted out and analyzed statistically. Results: 1. (1) The incidence of growth pain in children aged 3 to 7 years in Changsha was 15.2%; the frequency of GP was significantly different between boys and girls (P = 0.003); the nature of GP was significantly different between boys and girls (P = 0.001); the difference of GP duration between boys and girls was not statistically significant (P = 0.187); and (3) the frequency of GP was significantly different between boys and girls (P = 0.003); The proportion of boys going to hospital because of GP was higher than that of girls (P = 0.006). 2. (1) The univariate analysis of risk factors showed that: (1) 46.7% of the children in the case group had family history and 25.8% of the children in the control group had ball games, the difference was statistically significant; The proportion of children in the case group was higher than that in the control group (P = 0.043), the proportion of children in the case group was higher than that in the control group (P = 0.022), and the proportion of children in the case group was higher than that in the control group (P = 0.018). The proportion of normal gait was higher than that of the case group, and the difference was statistically significant (P = 0.034). _The time of physical activity in the case group was longer than that in the control group, and the difference was statistically significant (P = 0.001). _The degree of fatigue in the case group was higher than that in the control group, and the difference between the two groups was statistically significant (P = 0.001). The proportion of children picking food was higher than that of the control group, and the difference was statistically significant between the two groups (P = 0.027). 2. Multivariate unconditional logistic regression analysis showed that: (1) Family history was a risk factor for GP (OR = 2.116);; (2) picking food was a risk factor for GP (OR = 2.745); and (3) ball games were a risk factor for GP (OR = 1.279). (4) Gymnastics is a risk factor for GP. (OR = 2.354). _Normal gait is a protective factor for GP. (OR = 0.854). 3. Correlation analysis between growth pain and lower limb force line parameters showed that: (1) There was significant difference in lower limb force line between GP and non-GP groups (P = 0.027). 2) There was significant difference in lower limb torsion between GP and non-GP groups. (P = 0.041). There was a significant difference in foot posture between GP and non-GP groups (P = 0.019). There was a significant difference in joint relaxation between GP and non-GP groups (P = 0.017). 4. The EMG signal of lower limb muscle surface in children showed that: (1) the electromyographic activity of peroneus longus muscle in GP patients with standing pronation increased (P = 0.004); The gastrocnemius myoelectric activity decreased (P = 0.04) and the posterior tibial myoelectric activity increased (P = 0.001) in GP children with heel pronation. The second part: GP may have genetic factors. Early start of ball games and gymnastics in children may lead to the occurrence of GP, and the duration of each physical activity, the degree of fatigue after exercise is related to GP. Part 4: The electromyographic activity of the longus peroneus increased in children with GP in standing position, the electromyographic activity of the gastrocnemius decreased and the electromyographic activity of the posterior tibial muscle increased in elevating heel position. Changes in muscle activity may be responsible for the occurrence of GP when the foot line is abnormal.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R179
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