Takeuchi Chiaki, Sugiura Shiro, Fujita Remi, Tatematsu Noriatsu, Sugiura Hideshi
Rehabilitation Section, Clinical Support Division, Aichi Children's Health and Medical Canter, Obu, Aichi, Japan.
Department of Maternal and Child Health, Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
Clin Med Insights Pediatr. 2024 Sep 25;18:11795565241281334. doi: 10.1177/11795565241281334. eCollection 2024.
Caregivers are deeply concerned about children achieving independent walking, and evidence-based rehabilitation support is beneficial. However, current research is confined to a single study on spina bifida aperta, leaving a gap in understanding the timing of independent walking for lumbosacral lipomas.
This study aimed to examine the factors influencing independent walking in children with lumbosacral lipomas.
Retrospective cohort study.
This retrospective cohort study included 124 children who underwent untethering surgery for lumbosacral lipomas. The age (in months) at which the children walked independently was used as the primary endpoint, and potential influencing factors, including the type of spinal lipoma, extent of lipoma removal, magnetic resonance imaging features, congenital anomaly complications, urinary/defecation management requirements, foot/toe symptoms, and orthotic device fabrications were analyzed.
Multiple logistic regression analysis showed that the most significant influencing factor for delayed independent walking was the presence of systemic combined anomalies (adjusted odds ratio = 15.5, ), while non-systemic malformations, such as suburethral cleft, had limited effects. A subgroup analysis of 94 patients without systemic combined anomalies showed that the presence of a malformed conus medullaris was significantly associated with delayed independent walking ( ). The median age of independent walking in children with Morota's classification type 2 was 14 months, which is 1 month later compared to other types, although this difference was not significant ( ).
Our findings suggest that complications arising from systemic combined anomalies and the presence of malformed conus medullaris are influencing factors in delays in independent walking in children with untethered lumbosacral lipomas.
照顾者深切关注儿童实现独立行走，而基于证据的康复支持是有益的。然而，目前的研究仅限于一项关于开放性脊柱裂的单一研究，在了解腰骶部脂肪瘤患儿独立行走的时机方面存在空白。
本研究旨在探讨影响腰骶部脂肪瘤患儿独立行走的因素。
回顾性队列研究。
这项回顾性队列研究纳入了124例接受腰骶部脂肪瘤松解手术的儿童。将儿童独立行走的年龄（以月为单位）作为主要终点，并分析了潜在的影响因素，包括脊柱脂肪瘤的类型、脂肪瘤切除范围、磁共振成像特征、先天性异常并发症、泌尿/排便管理需求、足部/脚趾症状以及矫形器制作情况。
多因素logistic回归分析显示，独立行走延迟的最显著影响因素是存在全身性合并畸形（调整后的优势比=15.5， ），而诸如尿道下裂等非全身性畸形的影响有限。对94例无全身性合并畸形的患者进行的亚组分析显示，圆锥畸形的存在与独立行走延迟显著相关（ ）。Morota分类2型儿童独立行走的中位年龄为14个月，比其他类型晚1个月，尽管这种差异不显著（ ）。
我们的研究结果表明，全身性合并畸形引起的并发症以及圆锥畸形的存在是腰骶部脂肪瘤松解术后患儿独立行走延迟的影响因素。
