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中国循证儿科杂志

中国循证儿科杂志 ›› 2025, Vol. 20 ›› Issue (1): 9-21.DOI: 10.3969/j.issn.1673-5501.2025.01.002

• 论著 • 上一篇    下一篇

儿童和青少年脑性瘫痪肌张力与其他健康相关因素交互作用的系统综述

王翠1,李文竹1,谢旖婧2a,王维3,张崇凡2a,黄真1,史惟2b   

  1. 1 北京大学第一医院 北京，100034； 2 复旦大学附属儿科医院 上海，201102，a 临床指南制作和评价中心（复旦大学GRADE中心），b 康复科； 3 香港复康会


  • 收稿日期:2025-02-25 修回日期:2025-02-25 出版日期:2025-02-25 发布日期:2025-02-25
  • 通讯作者: 黄真;史惟

The interaction between muscle tone and other health-related factors in children and adolescents with cerebral palsy: A systematic review

WANG Cui1, LI Wenzhu1, XIE Yijing2a, WANG Wei3, ZHANG Chongfan2a, HUANG Zhen1, SHI Wei2b   

  1. 1 Peking University First Hospital, Beijing 100034; 2 Children's Hospital of Fudan University, a. Clinical Practivce Guideline Development and Evaluation Center, b. Rehabilitation Medicine Department, Shanghai 201102; 3 Hongkong Society for Rehabilitation, Hongkong, China

  • Received:2025-02-25 Revised:2025-02-25 Online:2025-02-25 Published:2025-02-25
  • Contact: HUANG Zhen；SHI Wei

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摘要： 背景：肌张力异常是导致脑瘫运动和姿势异常核心表现的主要因素，对脑瘫患者身体功能和结构、活动和参与以及生活质量各个层面造成不同程度的影响，目前缺乏肌张力异常会如何系统影响个体其他健康相关因素的系统综述。 目的：探讨儿童和青少年脑瘫肌张力与其他健康相关因素交互作用的研究现况。 设计：系统综述。 方法：：系统检索和筛选涉及儿童和青少年脑瘫肌张力与其他健康相关因素交互作用的文献；提取文献特征，包括脑瘫患儿年龄、性别、粗大运动功能分级系统（GMFCS）和脑瘫儿童手功能分级系统（MACS）、脑瘫类型、肌张力指标以及与之关联的其他健康信息指标、文献报告的交互性统计学方法：：；对关联的健康指标基于ICF-cy关联规则进行维度划分；通过构建的交互影响判断方法：：学进行肌张力与其他健康相关因素交互作用判断。 主要结局指标：肌张力与其他健康相关信息的交互。 结果：在中英文数据库共检索到19 831篇文献，106篇文献进入本文数据分析，英文92篇、中文14篇，共纳入14 021例儿童和青少年脑瘫。6篇未报告脑瘫类型，12篇不限制脑瘫类型，80篇为单纯痉挛型脑瘫，8篇为不随意运动型脑瘫；涉及锥体系的共出现评估指标120项（92.3%），锥体外系评估指标10项。纳入肌张力与其他健康相关指标648项，2 327条关联数据，关联指标数量前3位分别为上肢运动功能（172项，26.5%）、步态（118项，18.2%）和继发性肌肉骨骼障碍（72项，11.1%），关联数据条目占比前3位分别为步态（630条，27.1%）、上肢能力（288条，12.4%）和肌力与肌耐力（264条，11.3%）。相关性分析数据条目1 668项，回归分析数据条目444项，结构方程模型数据条目17项，验证因子分析数据条目13项，其他/未指明分析数据条目179项。通过交互作用判断方法：：学进行肌张力与其他维度之间的交互性判断。 结论：在儿童和青少年脑瘫中，与肌张力可能存在交互作用的包括：粗大运动、肌力和肌耐力、生活质量及继发性肌肉骨骼障碍；不确定存在交互作用的包括：步态、参与、日常生活活动和上肢功能；可能不存在交互作用的包括：身体活动。

关键词: 脑性瘫痪, 肌张力, 交互, 系统综述

Abstract: Background：Abnormal muscle tone is a major factor contributing to movement and postural abnormalities in children and adolescents with cerebral palsy. It significantly affects multiple aspects of body function and structure, activity and participation, and quality of life. However, a systematic review on how abnormal muscle tone systematically interacts with other health-related factors is currently lacking. Objective：To explore the current status of the interaction between muscle tone and other health-related factors in the children and adolescents with cerebral palsy. Design：Systematic review. Methods：A systematic search and screening process was conducted to identify studies examining the interaction between muscle tone and other health-related factors in children and adolescents with cerebral palsy. Characteristics of the studies were extracted including participant age, gender, Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), CP subtype, muscle tone assessment metrics, and associated health indicators. Statistical Methods： used to analyze interactions were also extracted. The associated health indicators were categorized based on the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY). A constructed methodological framework was applied to determine the interactions between muscle tone and other health-related factors. Main outcome measures：The current status of the interaction between muscle tone and other health-related factors. Results：A total of 19,831 studies were retrieved from Chinese and English databases, and 106 studies were included in the final analysis (92 in English, 14 in Chinese), comprising 14,021 children and adolescents with CP. Of these studies, 6 did not report CP subtype, 12 did not restrict CP subtype, 80 focused solely on spastic CP, and 8 focused on dyskinetic CP. The assessment included 120 pyramidal system indicators (92.3%) and 10 extrapyramidal system indicators. A total of 648 health-related factors with 2,327 interaction data items were included. The top three most frequently reported associated factors were upper limb motor function (172 items, 26.5%), gait (118 items, 18.2%), and secondary musculoskeletal disorders (72 items, 11.1%). The top three interaction data categories were gait (630 entries, 27.1%), upper limb motor ability (288 entries, 12.4%), and muscle strength and endurance (264 entries, 11.3%). Among the included studies, 1,668 entries reported correlation analysis, 444 entries used regression analysis, 17 entries employed structural equation modeling, 13 entries conducted confirmatory factor analysis, and 179 entries applied other and unspecified analytical Methods：. The methodological framework was used to determine interactions between muscle tone and other health-related dimensions. Conclusion：The factors that may interact with muscle tone in children and adolescents with cerebral palsy include gross motor skills, muscle strength and endurance, quality of life, and secondary musculoskeletal disorders. Uncertain interactive factors include gait, participation, activities of daily living, and upper limb function. The factor of physical activity may not interact with muscle tone.

Key words: Cerebral palsy, Muscle tone, Interaction, Systematic review