儿童生长痛的流行病学调查及与相关因素的分析

发布时间：2018-08-27 08:05

【摘要】：目的：生长痛(Growing pains, GP)是一种原因不明、发生在小儿生长最旺盛期之前的一种肢体痛症,临床上十分常见,但容易被医生漏诊和误诊,确切的发生机制仍不明确,至今也没有满意的治疗方法。本课题通过对长沙市3～7岁儿童生长痛的流行病现况研究,危险因素的病例对照研究,生长痛与下肢力线参数的相关性分析及长沙市生长痛儿童下肢肌肉表面肌电信号的病例对照研究。探讨生长痛的发生机制,以期为临床工作提供相应的参考依据。方法：1.2014年5月至2014年6月以年龄在3-7岁之间的幼儿及低年级小学生为调查对象,选取长沙市2所幼儿园与1所小学共1600名儿童。采用自行设计的《3-7岁儿童下肢生长痛情况调查问卷》实施横断面调查。在校方的认可及支持下,统一发放调查表,调查表于2天后由班主任统一收回。调查员现场测量研究儿童的下肢力线参数。剔除无效问卷后,对结果进行数据整理与统计分析。2.将2014年5月～10月期间在我院小儿骨科门诊就诊且诊断为生长痛伴旋前足的3～7岁儿童按抽样法随机选取48名儿童为病例组,同时确定非生长痛的48名对照组儿童,采用表面肌电测试系统,检测得出站立位、提踵位时所测试双侧胫骨前肌、腓骨长肌、胫骨后肌、腓肠肌的均方根值(Root mean square, RMS值)。对结果进行数据整理与统计分析。结果：1.现况调查结果显示：①长沙市3～7岁儿童生长痛的发生率为15.2%；②男女儿童之间GP发生的频率差异有统计学意义(P=0.003)；男女儿童之间GP发生的性质间差异有统计学意义(P=0.001)；男女儿童之间的GP持续时间的差异没有统计学意义(P=0.187)；③25.8%的GP患儿因为疼痛于医疗机构就诊过。男孩因为GP去医院就诊的比例高于女孩(P=0.006)。2.(1)危险因素的病例对照研究单因素分析结果显示：①病例组中46.7%有家族史,对照组中25.8%,两者比较差异有统计学意义；②病例组儿童开展球类运动的比例高于对照组,两组间差异有统计学意义(P=0.043)；③病例组儿童开展舞蹈项目的比例高于对照组,两组间差异有统计学意义(P=0.022)；④病例组儿童开展体操运动的比例高于对照组,两组间差异有统计学意义(P=0.018)；⑤对照组中正常步态的比例高于病例组,差异有统计学意义(P=0.034)；⑥病例组儿童每次进行体育活动的时间多于对照组,两组的差异有统计学意义(P=0.001)；⑦病例组儿童运动后疲劳程度较对照组高,两组的差异有统计学意义(P=0.001)；⑧病例组儿童挑食的比例高于对照组,两组间差异有统计学意义,(P=0.027)。2.(2)多因素非条件Logistic回归分析研究结果显示：①家族史是GP的危险因素(OR=2.116)；②儿童挑食是GP的危险因素(OR=2.745)；③儿童开展球类运动是GP的危险因素(OR=1.279)；④体操运动是GP的危险因素,(OR=2.354)。⑤正常步态是GP的保护因素(OR=0.854)。3.儿童生长痛与下肢力线参数的相关性分析结果显示：①GP与非GP两组儿童的下肢力线差异有统计学意义(P=0.027)。②GP与非GP两组儿童的下肢扭转差异有统计学意义(P=0.041)。③GP与非GP两组儿童的足部姿态差异有统计学意义(P=0.019)。④GP与非GP两组儿童的关节松弛差异有统计学意义(P=0.017)。4.儿童下肢肌肉表面肌电信号研究显示：①站立位旋前足GP患儿腓骨长肌肌电活动水平增加(P=0.004)；②提踵位旋前足GP患儿腓肠肌肌电活动减少(P=0.04),胫骨后肌肌电活动增加(P=0.001)。③当GP儿童足部力线异常时,肌肉活动的改变可能导致GP的发生。结论：第一部分：GP是长沙市3～7岁儿童的一种常见病痛。GP发生的频率、疼痛的性质、就诊的情况以及GP对正常生活的影响等与性别有关系。第二部分：GP可能存在遗传因素。儿童过早开始球类运动及体操可能导致GP的发生,而且每次进行体育活动的时间长短、运动后疲劳程度与GP有关。儿童步态异常、挑食是GP的危险因素。第三部分：儿童GP的发生与下肢力线差异、下肢扭转差异、足部姿态差异、关节松弛有关。第四部分：GP伴旋前足儿童在站立位时腓骨长肌的肌电活动水平出现增加；在提踵位时旋前足的腓肠肌肌电活动出现减少,胫骨后肌的肌电活动增加；足部力线异常时,肌肉活动的改变可能是导致GP发生的原因。
[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.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R179

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