Schmidt Steven M, Hägglund Gunnar, Alriksson-Schmidt Ann I
Department of Health Sciences, Lund University, Lund, Sweden.
Department of Clinical Sciences, Orthopedics, Skåne University Hospital, Lund University, Lund, Sweden.
Acta Paediatr. 2020 Mar;109(3):541-549. doi: 10.1111/apa.15006. Epub 2019 Sep 30.
To investigate the relationships between pain in the lower extremities and back, and spasticity, bone/joint complications and mobility.
Retrospective population-based registry study. Participants (N = 3256) with cerebral palsy (CP), 2.5-16 years of age, participating in the Swedish Cerebral Palsy Follow-up Program were included. Spasticity was measured using scissoring and the Modified Ashworth Scale. Bone/joint complications consisted of hip displacement, range of motion, windswept posture and scoliosis. Mobility was measured using the Functional Mobility Scale (5-, 50- and 500-metres), wheelchair use (outdoors) and the ability to stand/get up from sitting/use stairs, respectively. Pain was measured as presence of pain in hips, knees, feet and back. Data were analysed using structural equation modelling.
Bone/joint complications had the strongest direct pathway with pain in the lower extremities (standardised regression coefficient = 0.48), followed by reduced mobility (standardised regression coefficient = -0.24). The pathways between spasticity and pain, and age and pain were not significant. The R of the model was 0.15.
Bone/joint complications and reduced mobility were associated with pain in the lower extremities when controlling for sex. Considering the R of the model, other factors not included in the model are also associated with pain in the lower extremities in children with CP.
研究下肢与背部疼痛、痉挛、骨/关节并发症及活动能力之间的关系。
基于人群的回顾性登记研究。纳入参与瑞典脑瘫随访项目、年龄在2.5至16岁之间的3256例脑瘫（CP）患者。采用交叉步和改良Ashworth量表测量痉挛情况。骨/关节并发症包括髋关节脱位、活动范围、偏瘫姿势和脊柱侧弯。分别使用功能活动量表（5米、50米和500米）、轮椅使用情况（户外）以及站立/从坐姿起身/使用楼梯的能力来测量活动能力。疼痛通过髋部、膝盖、足部和背部是否存在疼痛来衡量。数据采用结构方程模型进行分析。
骨/关节并发症与下肢疼痛的直接关联最强（标准化回归系数 = 0.48），其次是活动能力下降（标准化回归系数 = -0.24）。痉挛与疼痛、年龄与疼痛之间的关联不显著。模型的R值为0.15。
在控制性别因素后，骨/关节并发症和活动能力下降与下肢疼痛相关。考虑到模型的R值，模型未纳入的其他因素也与脑瘫患儿的下肢疼痛有关。
