Wu Shuihua,Liang Dazhong.Analysis of factors related to ASQ-3 age and developmental process assessment questionnaire in children with nonsyndromic craniosynostosis after surgery[J].Journal of Clinical Pediatric Surgery,2023,22(08):762-767.[doi:10.3760/cma.j.cn101785-202304003-012]
非综合征性颅缝早闭患儿手术后ASQ-3年龄与发育进程问卷评估结果的相关因素分析
- Title:
- Analysis of factors related to ASQ-3 age and developmental process assessment questionnaire in children with nonsyndromic craniosynostosis after surgery
- 摘要:
- 目的 探讨影响非综合征性颅缝早闭患儿手术后ASQ-3年龄与发育进程问卷（以下简称ASQ-3问卷）评估结果的相关因素。方法 回顾性分析2016年6月至2022年6月湖南省儿童医院神经外科收治的68例非综合征性颅缝早闭患儿临床资料，由同一组儿童保健专家使用ASQ-3问卷对非综合征性颅缝早闭颅缝再造颅骨重塑手术后患儿进行沟通、粗大动作、精细动作、解决问题、个人-社会五个能区的评估。收集患儿测评年龄、性别、疾病类型、手术年龄、术后是否发热、父母亲及主要照顾者文化程度、ASQ-3问卷测评结果等信息。根据ASQ-3问卷结果将患儿分为发育正常组和发育欠佳组，分析影响非综合征性颅缝早闭患儿术后ASQ-3问卷评估结果的相关因素。结果 68例均获得ASQ-3问卷评估结果，在沟通、粗大动作、精细动作、解决问题和个人-社会五个能区上能力欠佳的检出率分别为23.5%（16/68）、35.3%（24/68）、32.4%（22/68）、35.3%（24/68）和26.5%（18/68）。39例（39/68，57.4%）评估结果为发育正常，29例（29/68，42.6%）为发育欠佳。两组患儿测评年龄、术后有无发热、母亲及主要照顾者文化程度差异有统计学意义（P<0.05）；手术年龄、父亲文化程度以及性别差异无统计学意义（P>0.05）。多因素Logistic回归分析结果显示，测评年龄增长（OR=0.896，95%CI：0.843~0.953）和术后出现发热（OR=0.173，95%CI：0.029~0.645）是手术后ASQ-3问卷测评结果为发育正常的保护因素（P<0.05）。结论 非综合征性颅缝早闭颅缝再造颅骨重塑手术后患儿ASQ-3问卷五个能区发育评估存在不同程度能力欠佳，测评年龄增长和术后发热是术后发育正常的保护因素。
- Abstract:
- Objective To explore the influencing factors for the results of ASQ-3 age and developmental process questionnaire in children with nonsyndromic craniosynostosis (NSC) after surgery.Methods The relevant clinical data were retrospectively reviewed for 68 hospitalized NSC children from June 2016 to June 2022.ASQ-3 questionnaire was employed for assessing the five capability domains of communication, gross motor, fine motor, problem-solving and personal-social after craniosuture reconstruction skull remodeling.Operative age, gender, disease type, assessment age, postoperative fever, educational level of parents and major caregivers and questionnaire assessments were collected.The influencing factors of ASQ-3 questionnaire were examined.Results The results of 68 ASQ-3 questionnaire were evaluated.The detection rates of poor capability in communication, gross motor, fine motor, problem-solving and individual-social domains were 23.5%(16/68), 35.3%(24/68), 32.4%(22/68), 35.3%(24/68) and 26.5%(18/68) respectively.And 39 children (39/68, 57.4%) had normal development and 29 children (29/68, 42.6%) poor development.Inter-group differences existed in assessment age, postoperative fever or not and paternal and primary caregiver education (P<0.05).Multi-factorial Logistic regression analysis indicated that higher assessment age (OR=0.896, 95%CI:0.843-0.953) and postoperative fever (OR=0.173, 95%CI:0.029-0.645) were the protective factors of normal postoperative development according to the results of ASQ-3 (P<0.05).Conclusion NSC children undergoing craniosuture reconstruction and skull remodeling have varying degrees of poor capability in five functional domains based upon ASQ-3 questionnaire.Higher assessment age and postoperative fever are the protective factors of normal postoperative development.
参考文献/References:
[1] Da Costa AC, Walters I, Savarirayan R, et al.Intellectual outcomes in children and adolescents with syndromic and nonsyndromic craniosynostosis[J].Plast Reconstr Surg, 2006, 118(1):175-181.DOI:10.1097/01.prs.0000221009.93022.50.
[2] 孙守庆, 鲍南.综合征型颅缝早闭的临床表现及基因诊断[J].临床小儿外科杂志, 2017, 16(4):409-412.DOI:10.3969/j.issn.1671-6353.2017.04.023. Sun SQ, Bao N.Clinical manifestations and genetic diagnoses of syndromic craniosynostoses[J].J Clin Ped Sur, 2017, 16(4):409-412.DOI:10.3969/j.issn.1671-6353.2017.04.023.
[3] 王安肯, 亢晓丽.颅缝早闭与斜视[J].中华眼科杂志, 2016, 52(8):626-630.DOI:10.3760/cma.j.issn.0412-4081.2016.08.018. Wang AK, Kang XL.Craniosynostosis and strabismus[J].Chin J Ophthalmol, 2016, 52(8):626-630.DOI:10.3760/cma.j.issn.0412-4081.2016.08.018.
[4] 文海韬, 顾硕, 吴水华.狭颅症的诊疗进展[J].临床小儿外科杂志, 2018, 17(2):146-149.DOI:10.3969/j.issn.1671-6353.2018.02.014. Wen HT, Gu S, Wu SH.Research advances of diagnosing and treating craniostenosis disease[J].J Clin Ped Sur, 2018, 17(2):146-149.DOI:10.3969/j.issn.1671-6353.2018.02.014.
[5] Tillman KK, H?ijer J, Ramklint M, et al.Nonsyndromic craniosynostosis is associated with increased risk for psychiatric disorders[J].Plast Reconstr Surg, 2020, 146(2):355-365.DOI:10.1097/PRS.0000000000007009.
[6] 潘维伟, 童笑梅.非综合征型颅缝早闭症术后矫形头盔治疗45例病例系列报告[J].中国循证儿科杂志, 2023, 18(1):62-65.DOI:10.3969/j.issn.1673-5501.2023.01.010. Pan WW, Tong XM.Non-syndromic craniosynostosis treated with orthopedic helmets after surgery:a serial report of 45 cases[J].Chin J Evid Based Pediatr, 2023, 18(1):62-65.DOI:10.3969/j.issn.1673-5501.2023.01.010.
[7] 中国儿童颅缝早闭症诊治协作组.儿童颅缝早闭症诊治专家共识[J].中华小儿外科杂志, 2021, 42(9):769-773.DOI:10.3760/cma.j.cn421158-20210208-00069. Collaborative Group on the Diagnosis and Treatment of Early Suture Syndrome in Children in China.Expert consensus on diagnosing and treating craniosynostosis in children[J].Chin J Pediatr Surg, 2021, 42(9):769-773.DOI:10.3760/cma.j.cn421158-20210208-00069.
[8] Governale LS.Craniosynostosis[J].Pediatr Neurol, 2015, 53(5):394-401.DOI:10.1016/j.pediatrneurol.2015.07.006.
[9] Kolar JC.An epidemiological study of nonsyndromal craniosynostoses[J].J Craniofac Surg, 2011, 22(1):47-49.DOI:10.1097/SCS.0b013e3181f6c2fb.
[10] Garza RM, Khosla RK.Nonsyndromic craniosynostosis[J].Semin Plast Surg, 2012, 26(2):53-63.DOI:10.1055/s-0032-1320063.
[11] Dempsey RF, Monson LA, Maricevich RS, et al.Nonsyndromic craniosynostosis[J].Clin Plast Surg, 2019, 46(2):123-139.DOI:10.1016/j.cps.2018.11.001.
[12] 许震宇, 鲍南, 张臻, 等.Crouzon综合征的临床和遗传学研究[J].中华神经外科杂志, 2014, 30(6):592-595.DOI:10.3760/cma.j.issn.1001-2346.2014.06.016. Xu ZY, Bao N, Zhang Z, et al.Clinical and genetic studies of Crouzon syndrome[J].Chin J Neurosurg, 2014, 30(6):592-595.DOI:10.3760/cma.j.issn.1001-2346.2014.06.016.
[13] Arnaud-López L, Fragoso R, Mantilla-Capacho J, et al.Crouzon with acanthosis nigricans.Further delineation of the syndrome[J].Clin Genet, 2007, 72(5):405-410.DOI:10.1111/j.1399-0004.2007.00884.x.
[14] Kruszka P, Addissie YA, Yarnell CM, et al.Muenke syndrome:an international multicenter natural history study[J].Am J Med Genet A, 2016, 170A(4):918-929.DOI:10.1002/ajmg.a.37528.
[15] Jenkins D, Seelow D, Jehee FS, et al.RAB23 mutations in Carpenter syndrome imply an unexpected role for hedgehog signaling in cranial-suture development and obesity[J].Am J Hum Genet, 2007, 80(6):1162-1170.DOI:10.1086/518047.
[16] 刘静, 田培玲, 杨继学, 等.狭颅症患儿手术预后的影响因素分析[J].浙江医学, 2022, 44(10):1110-1111.DOI:10.12056/j.issn.1006-2785.2022.44.10.2020-3235. Liu J, Tian PL, Yang JX, et al.Analysis of influencing factors on surgical prognosis in children with craniostenosis[J].Zhejiang Med J, 2022, 44(10):1110-1111.DOI:10.12056/j.issn.1006-2785.2022.44.10.2020-3235.
[17] Maltese G, Fischer S, Strandell A, et al.Spring-assisted surgery in the treatment of sagittal synostosis:a systematic review[J].J Plast Surg Hand Surg, 2015, 49(3):177-182.DOI:10.3109/2000656X.2014.981268.
[18] Di Rocco F, Ben Gbulie U, Meyer P, et al.Current techniques and protocols in the surgical management of scaphocephaly in young infants[J].J Craniofac Surg, 2014, 25(1):39-41.DOI:10.1097/SCS.0b013e3182a2f799.
[19] 姚红新.狭颅症该怎么治[J].人人健康, 2016, (11):70. Yao HX.Treatments of cranial stenosis[J].Health for Everyone, 2016, (11):70.
[20] 朱红芬.外科术后发热预防措施与对策研究[J].中外医学研究, 2016, 14(25):163-164.DOI:10.14033/j.cnki.cfmr.2016.25.088. Zhu HF.Preventive measures and countermeasures for postoperative fever in surgery[J].Chin Foreign Med Res, 2016, 14(25):163-164.DOI:10.14033/j.cnki.cfmr.2016.25.088.
[21] 林彬, 李光照, 杨非, 等.颅骨修补术后发热的危险因素及原因分析[J].立体定向和功能性神经外科杂志, 2021, 34(1):41-44.DOI:10.19854/j.cnki.1008-2425.2021.01.0011. Lin B, Li GZ, Yang F, et al.Risk factors and cause analysis of fever after skull repair surgery[J].Chin J Stereotact Funct Neurosurg, 2021, 34(1):41-44.DOI:10.19854/j.cnki.1008-2425.2021.01.0011.
[22] 孟琨, 王蕾, 刘志达, 等.颅脑肿瘤患者术后发热原因分析[J].中国临床保健杂志, 2019, 22(3):417-419.DOI:10.3969/J.issn.1672-6790.2019.03.035. Meng K, Wang L, Liu ZD, et al.Analysis of causes of postoperative fever in brain tumors[J].Chin J Clin Healthc, 2019, 22(3):417-419.DOI:10.3969/J.issn.1672-6790.2019.03.035.
[23] 王睿智, 师蔚, 周任, 等.后颅凹肿瘤术后发热的原因及治疗[J].现代肿瘤医学, 2011, 19(4):668-670.DOI:10.3969/j.issn.1672-4992.2011.04.14. Wang RZ, Shi W, Zhou R, et al.Causes and treatments of postoperative fever in posterior fossa tumor[J].J Mod Oncol, 2011, 19(4):668-670.DOI:10.3969/j.issn.1672-4992.2011.04.14.
[24] Patel A, Yang JF, Hashim PW, et al.The impact of age at surgery on long-term neuropsychological outcomes in sagittal craniosynostosis[J].Plast Reconstr Surg, 2014, 134(4):608e-617e.DOI:10.1097/PRS.0000000000000511.
[25] Renier D, Lajeunie E, Arnaud E, et al.Management of craniosynostoses[J].Childs Nerv Syst, 2000, 16(10/11):645-658.DOI:10.1007/s003810000320.
[26] Persing JA.MOC-PS(SM) CME article:management considerations in the treatment of craniosynostosis[J].Plast Reconstr Surg, 2008, 121(4 Suppl):1-11.DOI:10.1097/01.prs.0000305929.40363.bf.
[27] Kapp-Simon KA, Figueroa A, Jocher CA, et al.Longitudinal assessment of mental development in infants with nonsyndromic craniosynostosis with and without cranial release and reconstruction[J].Plast Reconstr Surg, 1993, 92(5):831-839.DOI:10.1097/00006534-199392050-00008.
[28] 耿健, 董辉, 周启荣, 等.颅缝再造术与颅盖成形术治疗狭颅症的对比研究[J].中国实用神经疾病杂志, 2017, 20(2):29-31.DOI:10.3969/j.issn.1673-5110.2017.02.011. Geng J, Dong H, Zhou QR, et al.A comparative study of cranial suture reconstruction and cranioplasty for cranial stenosis[J].Chin J Pract Nerv Dis, 2017, 20(2):29-31.DOI:10.3969/j.issn.1673-5110.2017.02.011.
[29] Kapp-Simon KA, Wallace E, Collett BR, et al.Language, learning, and memory in children with and without single-suture craniosynostosis[J].J Neurosurg Pediatr, 2016, 17(5):578-588.DOI:10.3171/2015.9.PEDS15238.
[30] Mendonca DA, White N, West E, et al.Is there a relationship between the severity of metopic synostosis and speech and language impairments?[J].J Craniofac Surg, 2009, 20(1):85-88.DOI:10.1097/SCS.0b013e3181955244.
[31] Korpilahti P, Saarinen P, Hukki J.Deficient language acquisition in children with single suture craniosynostosis and deformational posterior plagiocephaly[J].Childs Nerv Syst, 2012, 28(3):419-425.DOI:10.1007/s00381-011-1623-6.
[32] Bellew M, Liddington M, Chumas P, et al.Preoperative and postoperative developmental attainment in patients with sagittal synostosis:5-year follow-up[J].J Neurosurg Pediatr, 2011, 7(2):121-126.DOI:10.3171/2010.11.PEDS10216.
[33] Glass GE, O’Hara J, Canham N, et al.ERF-related craniosynostosis:the phenotypic and developmental profile of a new craniosynostosis syndrome[J].Am J Med Genet A, 2019, 179(4):615-627.DOI:10.1002/ajmg.a.61073.
[34] Care H, Kennedy-Williams P, Culshaw L, et al.Craniofacial collaboration UK:developmental outcomes in 5-year-old children with sagittal synostosis[J].J Craniofac Surg, 2021, 32(1):51-54.DOI:10.1097/SCS.0000000000006973.
相似文献/References:
[1]伍添,吴水华.NFIA基因突变致脑畸形伴或不伴尿道缺陷疾病诊治分析[J].临床小儿外科杂志,2021,20(09):866.[doi:10.12260/lcxewkzz.2021.09.013]
Wu Tian,Wu Shuihua.Brain malformation with or without urethral defect due to NFIA gene mutation: one case report with a literature review[J].Journal of Clinical Pediatric Surgery,2021,20(08):866.[doi:10.12260/lcxewkzz.2021.09.013]
[2]李制一,汪婧怡,顾硕.颅缝早闭的诊治现状及未来研究方向[J].临床小儿外科杂志,2024,(02):101.[doi:10.3760/cma.j.cn101785-202401007-001]
Li Zhiyi,Wang Jingyi,Gu Shuo.Current status of diagnosing and treating craniosynostosis and future research directions[J].Journal of Clinical Pediatric Surgery,2024,(08):101.[doi:10.3760/cma.j.cn101785-202401007-001]
[3]刘雨桐,曾高.不同年龄段矢状缝早闭的手术治疗探讨[J].临床小儿外科杂志,2024,(02):109.[doi:10.3760/cma.j.cn101785-202312012-002]
Liu Yutong,Zeng Gao.Surgical management of sagittal synostosis at different ages[J].Journal of Clinical Pediatric Surgery,2024,(08):109.[doi:10.3760/cma.j.cn101785-202312012-002]
[4]张迪,葛明,马文平,等.π型截骨术后辅助头盔治疗与颅骨重建术治疗婴幼儿非综合征型矢状缝早闭的疗效比较[J].临床小儿外科杂志,2024,(02):113.[doi:10.3760/cma.j.cn101785-202312054-003]
Zhang Di,Ge Ming,Ma Wenping,et al.A comparison of π craniectomy plus orthopedic helmet versus cranial vault remodeling for non-syndromic premature sagittal suture in infants[J].Journal of Clinical Pediatric Surgery,2024,(08):113.[doi:10.3760/cma.j.cn101785-202312054-003]
[5]李森,詹琪佳,肖波,等.额眶前移手术对额缝早闭患儿额叶容量及社会情绪改善的效果评价[J].临床小儿外科杂志,2024,(02):119.[doi:10.3760/cma.j.cn101785-202311041-004]
Li Sen,Zhan Qijia,Xiao Bo,et al.Improvements of frontal lobe volume and social emotions on metopic synostosis with frontal-orbital advancement[J].Journal of Clinical Pediatric Surgery,2024,(08):119.[doi:10.3760/cma.j.cn101785-202311041-004]
[6]许新科,林浩铭,林炜,等.儿童颅缝早闭二次手术影响因素分析[J].临床小儿外科杂志,2024,(02):125.[doi:10.3760/cma.j.cn101785-202312002-005]
Xu Xinke,Lin Haoming,Lin Wei,et al.Risk factors of secondary operation for craniosynostosis in children[J].Journal of Clinical Pediatric Surgery,2024,(08):125.[doi:10.3760/cma.j.cn101785-202312002-005]
[7]吴水华,Dae-jung Yang.以健侧为镜像治疗单侧冠状缝早闭症疗效分析[J].临床小儿外科杂志,2024,(02):130.[doi:10.3760/cma.j.cn101785-202312004-006]
Wu Shuihua,Dae-jung Yang.Efficacy of unilateral coronal craniostenosis using healthy side as a mirror image[J].Journal of Clinical Pediatric Surgery,2024,(08):130.[doi:10.3760/cma.j.cn101785-202312004-006]
备注/Memo
收稿日期:2023-04-02。
基金项目:湖南省出生缺陷协同防治科技重大专项（2019SK1010）；国家临床重点专科建设项目-湖南省儿童医院小儿外科[湘卫医发（2022）2号]
通讯作者:梁大中,Email:pt6226@sehan.ac.kr