不同类型形态性头颅畸形婴幼儿的神经心理发育特征

doi:10.3969/j.issn.1006-9771.2023.05.012

摘要/Abstract

摘要：

目的比较不同类型形态性头颅畸形婴幼儿的神经心理发育状况。

方法 2020年1月至2021年8月，选择在北京儿童医院体检门诊接受颅型测量和0-6岁儿童神经心理发育量表测量的0~18月龄儿童954例，依据颅型测量结果分为短头组、斜头组、不对称短头组、舟状头组和正常组，并根据0~6岁儿童神经心理发育量表计算发育商(DQ)。

结果头颅正常组449例，短头组94例，斜头组201例，不对称短头组82例，舟状头组128例。其中，短头组大运动能区“发育边缘和发育迟缓”(DQ < 85)检出率最高(60.6%)，不对称短头组精细动作(64.6%)、语言(45.1%)、适应性(51.2%)和社会行为能区(48.8%)“发育边缘和发育迟缓”检出率最高。5组间除语言能区外，其他4个能区DQ均有非常高度显著性差异(F > 14.835, P < 0.001)；与正常组比较，除舟状头组外，其余3组4个能区DQ下降(P < 0.05)；斜头组大运动、精细动作和适应性能区DQ高于不对称短头组(P < 0.05)，斜头组大运动和精细动作能区DQ高于短头组(P < 0.05)。线性回归分析显示，DQ与头部比率和头颅不对称指数负相关(|B| > 0.967, P < 0.05)。

结论 4种头颅畸形中，舟状头发育水平接近正常，短头、斜头和不对称短头在婴幼儿期有不同程度发育落后，主要表现在大运动、精细动作、适应性和社交行为方面。头颅畸形越重，各能区发育落后风险越大。

关键词: 头颅畸形, 神经心理发育, 发育迟缓, 婴幼儿

Abstract:

Objective To compare the neuropsychological development of infants with different types of morphologic cranial deformities.

Methods A total of 954 children aged 0 to 18 months who came to Beijing Children's Hospital from January, 2020 to August, 2021 for cranial measurement and neuropsychological development measurement were selected. They were divided into brachycephaly group, plagiocephaly group, asymmetric brachycephaly group, scaphocephaly group and normal group according to the cranial measurement. The development quotient (DQ) was calculated from Children Neuropsychological Development Scale (0-6).

Results There were 449 cases in the normal group, 94 cases in the brachycephaly group, 201 cases in the plagiocephaly group, 82 cases in the asymmetric brachycephaly group and 128 cases in the scaphocephaly group. The detection rate of Developmental Edge and Delay (DQ < 85) for gross motor area was the most in brachycephaly group (60.6%), and it was the most for fine motor (64.6%), language (45.1%), adaption (51.2%) and social behavior areas (48.8%) in the asymmetrical brachycephaly group. The DQ was different among the five groups for all the areas except the language area (F > 14.835, P < 0.001); compared with the normal group, DQ decreased for all the four areas in all the groups except the scaphocephaly group; DQ of the areas of gross motor, fine motor and adaption was more in the plagiocephaly group than in the asymmetric brachycephaly group (P < 0.05), while DQ of the areas of gross motor and fine motor was more in the plagiocephaly group than in the brachycephaly group (P < 0.05). Linear regression analysis showed that, DQ negative linear correlated with the cephalic ratio and cranial vault asymmetry index (|B| > 0.967, P < 0.05).

Conclusion Among four kinds of cranial malformation in infants, the neuropsychological development of the scaphocephaly group is almost normal, and somehow delays for brachycephaly, plagiocephaly and asymmetric brachycephaly, especially in the aspects of gross motor, fine motor, adaption and social behavior. The more serious the cranial deformity, the greater the risk of developmental delay in each functional area.

Key words: cranial deformity, neuropsychological development, developmental retardation, infants

中图分类号:

R682.1

张晚霞, 杨晨璐, 钱月, 王颖, 梁爱民. 不同类型形态性头颅畸形婴幼儿的神经心理发育特征[J]. 《中国康复理论与实践》, 2023, 29(5): 570-575.

ZHANG Wanxia, YANG Chenlu, QIAN Yue, WANG Ying, LIANG Aimin. Characteristics of neuropsychological development in infants with different types of morphological cranial malformation[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 570-575.

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组别	n	性别(男/女)/n	年龄/月	CR	CVAI
正常组	449	238/211	7.00±3.13	0.81±0.04	1.57±0.95
短头组	94	55/39	7.40±3.83	0.95±0.05	1.83±0.96
斜头组	201	121/80	6.87±3.28	0.82±0.05	5.46±1.63
不对称短头组	82	48/34	6.02±2.20	0.95±0.04	6.69±2.42
舟状头组	128	69/59	7.49±3.33	0.73±0.02	1.56±1.00
χ²/F值		3.703	3.134	-	-
P值		0.448	0.014	-	-

组别	n	大运动	精细动作	适应性	语言	社会行为
正常组	449	108(24.1)	152(33.9)	102(22.7)	119(26.5)	104(23.2)
短头组	94	57(60.6)	52(55.3)	39(41.5)	42(44.7)	42(44.7)
斜头组	201	90(44.8)	92(45.8)	60(29.9)	67(33.3)	78(38.8)
不对称短头组	82	48(58.5)	53(64.6)	42(51.2)	37(45.1)	40(48.8)
舟状头组	128	29(22.7)	37(28.9)	33(25.8)	30(23.4)	32(25.0)
χ²值		88.009	47.958	36.155	24.079	41.099
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

组别	n	大运动	精细动作	适应性	语言	社会行为
正常组	449	90.99±13.053	87.93±13.038	91.08±13.581	89.97±13.494	91.31±12.314
短头组	94	78.85±16.085	78.40±17.399	83.10±15.845	83.43±14.059	82.61±17.273
斜头组	201	84.86±17.229	84.40±15.161	87.46±15.437	90.51±66.415	85.60±15.789
不对称短头组	82	77.63±18.324	75.54±17.832	79.89±17.914	80.63±16.619	81.50±18.351
舟状头组	128	92.23±13.571	88.98±12.409	90.61±13.144	91.29±12.740	91.47±12.757
F值		27.917	20.981	14.835	2.353	16.705
P值		< 0.001	< 0.001	< 0.001	0.052	< 0.001

能区	组别		短头组	斜头组	不对称短头组	舟状头组	能区	组别		短头组	斜头组	不对称短头组	舟状头组
大运动	正常组	t值	12.136	6.124	13.361	-1.246	语言	正常组	t值	6.533	-0.549	9.333	-1.320
		P值	< 0.001	< 0.001	< 0.001	1.000			P值	0.800	1.000	0.183	1.000
	短头组	t值		-6.012	1.255	-13.382		短头组	t值		-7.081	2.800	-7.853
		P值		0.013	1.000	< 0.001			P值		0.850	1.000	0.789
	斜头组	t值			7.237	-7.370		斜头组	t值			9.882	-0.771
		P值			0.002	< 0.001			P值			0.220	1.000
	不对称短头组	t值				-14.607		不对称短头组	t值				-10.653
		P值				< 0.001			P值				0.222
精细动作	正常组	t值	9.528	3.531	12.395	-1.052	社会行为	正常组	t值	8.695	5.707	9.806	-0.158
		P值	< 0.001	0.038	< 0.001	1.000			P值	< 0.001	< 0.001	< 0.001	1.000
	短头组	t值		-5.997	2.867	-10.581		短头组	t值		-2.988	1.111	-8.852
		P值		0.009	1.000	< 0.001			P值		0.944	1.000	< 0.001
	斜头组	t值			8.864	-4.584		斜头组	t值			4.099	-5.865
		P值			< 0.001	0.048			P值			0.287	0.003
	不对称短头组	t值				-13.447		不对称短头组	t值				-9.964
		P值				< 0.001			P值				< 0.001
适应性	正常组	t值	7.979	3.625	11.194	0.467
		P值	< 0.001	0.035	< 0.001	1.000
	短头组	t值		-4.354	3.215	-7.512
		P值		0.170	1.000	0.002
	斜头组	t值			7.568	-3.158
		P值			0.001	0.556
	不对称短头组	t值				-10.726
		P值				< 0.001

能区	自变量	B	SE	β	t值	P值	95% CI
大运动	CR	-60.448	6.278	-0.297	-9.629	<0.001	-72.768~-48.129
	CVAI	-1.567	0.212	-0.234	-7.394	< 0.001	-1.983~-1.151
精细动作	CR	-54.259	6.020	-0.281	-9.013	< 0.001	-66.073~-42.445
	CVAI	-1.190	0.204	-0.187	-5.827	< 0.001	-1.591~-0.789
适应性	CR	-41.751	6.072	-0.215	-6.876	< 0.001	-53.667~-29.836
	CVAI	-1.084	0.203	-0.170	-5.338	< 0.001	-1.483~-0.686
语言	CR	-45.413	13.754	-0.106	-3.302	0.001	-72.404~-18.421
	CVAI	-0.967	0.457	-0.069	-2.114	0.035	-1.864~-0.069
社会行为	CR	-45.410	5.996	-0.238	-7.574	< 0.001	-57.177~-33.644
	CVAI	-1.321	0.200	-0.210	-6.603	< 0.001	-1.714~-0.928