Himmelmann K, Beckung E, Hagberg G, Uvebrant P
Department of Paediatrics, The Queen Silvia Children's Hospital/Sahlgrenska University Hospital, Göteborg, Sweden.
Dev Med Child Neurol. 2006 Jun;48(6):417-23. doi: 10.1017/S0012162206000922.
The aim of this study was to describe and analyze gross and fine motor function and accompanying neurological impairments in children with cerebral palsy (CP) born between 1991 and 1998 in western Sweden. A population-based study comprised 411 children with a diagnosis of CP ascertained at 4 to 8 years of age. Gross Motor Function Classification System (GMFCS) levels were documented in 367 children (205 males, 162 females). Bimanual Fine Motor Function (BFMF) classification levels of 345 of the children and information on learning disability, epilepsy, visual and hearing impairments, and hydrocephalus from 353 children were obtained. For spastic CP, a new classification according to the Surveillance of Cerebral Palsy in Europe of uni- and bilateral spastic CP was applied. GMFCS was distributed at Level I in 32%, Level II in 29%, Level III in 8%, Level IV in 15%, and Level V in 16%. The corresponding percentages for BFMF were 30.7%, 31.6%, 12.2%, 11.9%, and 13.6% respectively. Learning disability was present in 40%, epilepsy in 33%, and severe visual impairment in 19% of the children. Motor function differed between CP types. More severe GMFCS levels correlated with larger proportions of accompanying impairments and, in children born at term, to the presence of adverse peri/neonatal events in the form of intracranial haemorrhage/stroke, cerebral infection, and hypoxic-ischaemic encephalopathy. GMFCS Level I correlated positively to increasing gestational age. We conclude that the classification of CP should be based on CP type and motor function, as the two combine to produce an indicator of total impairment load.
本研究旨在描述和分析1991年至1998年出生于瑞典西部的脑瘫（CP）儿童的粗大和精细运动功能以及伴随的神经功能障碍。一项基于人群的研究纳入了411名4至8岁确诊为CP的儿童。记录了367名儿童（205名男性，162名女性）的粗大运动功能分类系统（GMFCS）水平。获取了345名儿童的双手精细运动功能（BFMF）分类水平以及353名儿童的学习障碍、癫痫、视力和听力障碍以及脑积水的信息。对于痉挛型CP，采用了欧洲脑瘫监测中关于单侧和双侧痉挛型CP的新分类方法。GMFCS分布情况为：I级占32%，II级占29%，III级占8%，IV级占15%，V级占16%。BFMF的相应百分比分别为30.7%、31.6%、12.2%、11.9%和13.6%。40%的儿童存在学习障碍，33%的儿童患有癫痫，19%的儿童有严重视力障碍。不同类型的CP运动功能存在差异。GMFCS水平越严重，伴随障碍的比例越高，对于足月儿来说，还与颅内出血/中风、脑部感染和缺氧缺血性脑病等围产期/新生儿不良事件的发生有关。GMFCS I级与孕周增加呈正相关。我们得出结论，CP的分类应基于CP类型和运动功能，因为两者结合可产生总损伤负荷的指标。
