中山市青少年特发性脊柱侧凸状况和相关因素

黄思哲; 李锋华; 杨军林; 唐卫明; 黄紫房; 高亿豪; 程梦圆

doi:10.16835/j.cnki.1000-9817.2023.06.029

中山市青少年特发性脊柱侧凸状况和相关因素

doi: 10.16835/j.cnki.1000-9817.2023.06.029

黄思哲¹,
李锋华¹,
杨军林^{2, 3, 4},
唐卫明⁵,
黄紫房³,
高亿豪⁴,
程梦圆^{4, 5, ,}

1.
广东省中山市中小学卫生保健所，528400
2.
上海交通大学医学院附属新华医院脊柱中心
3.
中山大学附属第三医院脊柱外科
4.
广东省新苗脊柱侧弯预防中心
5.
北卡罗来纳大学教堂山分校中国项目办

基金项目:

中山市卫生健康局医学科研项目 2019J441

国家自然科学基金面上项目 82072519

国家自然科学基金海外及港澳学者合作研究基金 81828007

详细信息

作者简介:
黄思哲(1977-)，女，广东台山人，大学本科，副主任医师，主要研究方向为学校健康教育与健康促进

通讯作者:
程梦圆，E-mail：mengyuan.cheng@outlook.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R726.8 R179 R193
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- 被引次数: 0
出版历程
- 收稿日期: 2022-11-22
- 修回日期: 2023-03-07
- 网络出版日期: 2023-06-28
- 刊出日期: 2023-06-25

Prevalence and factors influencing adolescent idiopathic scoliosis in Zhongshan City

1.
Zhongshan Municipal Primary and Secondary School Health Care Center, Zhongshan(528400), Guangdong Province, China

摘要

摘要: 目的探索青少年特发性脊柱侧凸(AIS)的影响因素，为其有效防治提供科学依据。方法对2019年4月至2020年3月参加中山市中小学生脊柱侧凸筛查项目的6 757名10~16岁学生进行问卷调查。筛查采用目视检查，Adams前屈试验下进行躯干旋转角度测量法，问卷调查收集学生个人及家庭基本情况、脊柱侧凸家族史、日常姿势习惯、背包习惯、视力情况、健康情况、学校环境、运动情况等相关信息。采用χ²检验和Logistic回归分析AIS的相关因素。结果 AIS的阳性筛查率为2.0%(135名)。多因素Logistic回归分析结果显示，女生、无AIS家族史学生、站立腰部前倾、习惯左侧倾斜坐姿、家庭月收入>10 000元与青少年AIS的发生有关(OR值分别为3.01，0.38，2.29，1.74，0.44，P值均＜0.05)。结论中山市10~16岁女生以及有脊柱侧凸家族史学生的脊柱侧凸患病风险较高，是筛查的重点人群。培养正确站姿、坐姿习惯有助于降低青少年AIS发生的风险。
- 脊柱侧凸 /
- 患病率 /
- 回归分析 /
- 青少年
Abstract: Objective To investigate factors influencing adolescent idiopathic scoliosis (AIS), and to provide a scientific basis for effective prevention and treatment programs. Methods A questionnaire survey was conducted among 6 757 students who participated in the scoliosis screening program for primary and middle school students in Zhongshan City, China from April 2019 to March 2020. Visual examination and Adams flexion test were used to measure the rotation angle of trunk. For each student, individual and family demographics, family history of scoliosis, daily postural habits, school-bag carrying habits, vision, health, school environment, and physical activity were collected by questionnaire. Factors influencing AIS were analyzed using Chi-square test and multivariate Logistic regression. Results The positive screening rate for AIS was 2.0%(135 cases). Multivariate Logistic regression analysis revealed that female gender, no family history of AIS, standing with lumbar spine tilted forward, habit of leaning to the left when seated, and a monthly family income of >10 000 yuan were related to the occurrence of AIS in adolescents (OR=3.01, 0.38, 2.29, 1.74, 0.44, P < 0.05). Conclusion Female students aged 10-16 years with a family history of scoliosis in Zhongshan are identified as a high-risk group for scoliosis screening. Developing proper standing and sitting habits helps to reduce the risk of AIS in adolescents.
- Scoliosis /
- Prevalence /
- Regression analysis /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同组别青少年AIS筛查阳性率比较

Table 1. Comparison of positive rate among different groups in adolescent idiopathic scoliosis

组别	选项	人数	筛查阳性人数	χ²值	P值	组别	选项	人数	筛查阳性人数	χ²值	P值
性别	女	3 114	105(3.37)	55.68	< 0.01		时常提醒自己	1 281	28(2.18)
	男	3 643	30(0.82)				时刻保持良好姿势	1 255	14(1.11)
民族	汉族	6 455	132(2.04)	1.63	0.20	视力状况	正常	3 364	58(1.72)	2.56	0.11
	其他民族	302	3(0.99)				近视	2 978	69(2.31)
父/母最高学历	初中/中专	3 008	60(1.99)	6.48	0.09	教室座位是否左右轮转	是	5 540	105(1.89)	1.65	0.20
	高中	1 847	40(2.16)				否	1 217	30(2.46)
	大学专科	1 123	28(2.49)			教室光线强度	较强	492	5(1.01)	2.62	0.27
	大学本科及以上	779	7(0.89)				适中	6 161	128(2.07)
家庭月收入/元	< 5 000	2 025	51(2.51)	10.98	< 0.01		较弱	104	2(1.92)
	5 000~10 000	2 848	63(2.21)			书包重量	较轻	569	4(0.70)	15.43	< 0.01
	> 10 000	1 884	21(1.11)				适中	3 188	50(1.56)
脊柱侧凸家族史(限直系亲属)	有	177	10(5.64)	29.36	< 0.01		较重	3 000	81(2.7)
	无	5 870	97(1.65)			鞋底磨损情况(左右脚)	没有差别	5 857	107(1.82)	9.27	0.01
	不清楚	710	28(3.94)				左脚磨损更严重	373	15(4.02)
习惯采用站姿	笔直	4 895	70(1.43)	34.01	< 0.01		右脚磨损更严重	527	13(2.46)
	腰部前倾	154	9(5.84)			鞋底磨损情况(内外侧)	没有差别	5 311	90(1.69)	11.85	< 0.01
	含背哈腰	1 708	56(3.27)				内侧磨损更严重	323	11(3.40)
教室桌椅高度	合适	4 757	75(1.57)	14.82	< 0.01		外侧磨损更严重	1 123	34(3.02)
	过低	1 576	46(2.91)			是否在课外参加补习班	是	2 414	47(1.94)	0.05	0.82
	过高	424	14(3.30)				否	4 343	88(2.02)
家中桌椅高度	合适	4 432	69(1.55)	13.59	< 0.01	过去1年整体健康情况	较好	5 817	102(1.75)	1.83	0.77
	过低	1 646	44(2.67)				一般	902	32(3.54)
	过高	679	22(3.24)				较差	38	1(2.63)
直立端正坐	是	2 485	25(1.01)	19.75	< 0.01	肩、颈酸痛	无	5 499	100(1.81)	4.86	0.03
	否	4 272	110(2.57)				有	1 258	35(2.78)
塌腰坐	是	1 391	41(2.95)	8.07	< 0.01	背部酸痛	无	6 293	122(1.93)	1.64	0.20
	否	5 366	94(1.75)				有	464	13(2.80)
向前趴着坐	是	2 605	51(1.96)	0.03	0.85	腰部酸痛	无	6 280	124(1.97)	0.25	0.62
	否	4 152	84(2.02)				有	477	11(2.30)
向左侧斜坐	是	618	28(4.53)	22.29	< 0.01	高低肩	无	6 384	115(1.80)	22.82	< 0.01
	否	6 139	107(1.74)				有	373	20(5.36)
向右侧斜坐	是	513	16(3.12)	3.56	0.06	从未遇到上述健康问题	是	4 187	61(1.45)	16.45	< 0.01
	否	6 244	119(1.91)				否	2 570	74(2.87)
胸口贴桌子坐	是	1 173	19(1.62)	1.04	0.31	羽毛球	不参与	4 877	102(2.09)	0.78	0.38
	否	5 584	116(2.08)				参与	1 880	33(1.75)
翘二郎腿坐	是	846	24(2.84)	3.48	0.06	篮球	不参与	4 145	108(2.60)	20.22	< 0.01
	否	5 911	111(1.88)				参与	2 612	27(1.03)
是否在教室午休	是	4 678	100(2.13)	1.52	0.22	游泳	不参与	5 185	108(2.08)	0.82	0.36
	否	2 079	35(1.68)				参与	1 572	27(1.71)
睡姿	俯卧位	470	3(0.63)	24.33	< 0.01	舞蹈	不参与	6 245	119(1.90)	3.59	0.06
	仰卧位	3 120	41(1.31)				参与	512	16(3.12)
	左侧卧位	1 572	46(2.92)			乒乓球	不参与	5 596	123(2.19)	6.66	0.01
	右侧卧位	1 595	45(2.82)				参与	1 161	12(1.03)
床垫柔软度	偏硬	1 158	29(2.50)	2.06	0.36	足球	不参与	5 943	130(2.18)	9.05	< 0.01
	适中	5 331	102(1.91)				参与	814	5(0.61)
	偏软	268	4(1.49)			基本不参与体育锻炼	否	5 844	104(1.77)	10.53	< 0.01
对站姿、坐姿的自我要求	无所谓	1 369	30(2.19)	6.13	0.11		是	913	31(3.39)
	有时会监督自己	2 852	63(2.20)
注：()内数字为筛查阳性率/%。

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表 2 青少年AIS筛查阳性相关因素的Logistic回归分析(n=6 757)

Table 2. Logistic regression analysis of influencing factors on positive screening for adolescent idiopathic scoliosis(n=6 757)

自变量	选项	调整前		调整后
自变量	选项	OR值(95%CI)	P值	OR值(95%CI)	P值
性别	女	4.20(2.79~6.32)	< 0.01	3.01(1.93~4.71)	< 0.01
家庭月收入/元	5 000~10 000	0.88(0.60~1.27)	0.48	0.85(0.57~1.27)	0.44
	> 10 000	0.44(0.26~0.73)	< 0.01	0.44(0.25~0.78)	< 0.01
脊柱侧凸家族史(限直系亲属)	无	0.28(0.14~0.55)	< 0.01	0.38(0.19~0.77)	< 0.01
	不清楚	0.69(0.33~1.44)	0.32	0.69(0.32~1.50)	0.35
习惯采用站姿	腰部前倾	4.28(2.10~8.73)	< 0.01	2.29(1.06~4.94)	0.04
	含背哈腰	2.34(1.64~3.34)	< 0.01	1.47(0.97~2.21)	0.07
教室桌椅高度	过低	1.88(1.29~2.72)	< 0.01	1.21(0.75~1.96)	0.44
	过高	2.13(1.19~3.81)	0.01	1.18(0.60~2.31)	0.64
家中桌椅高度	过低	1.74(1.18~2.55)	< 0.01	1.00(0.61~1.64)	0.99
	过高	2.12(1.30~3.45)	< 0.01	1.43(0.81~2.55)	0.22
直立端正坐	是	0.38(0.25~0.60)	< 0.01	0.81(0.48~1.36)	0.43
塌腰坐	是	1.70(1.17~2.47)	< 0.01	0.92(0.61~1.38)	0.68
向左侧斜坐	是	2.68(1.75~4.09)	< 0.01	1.74(1.10~2.74)	0.02
睡姿	俯卧位	0.48(0.15~1.56)	0.23	0.47(0.14~1.55)	0.22
	左侧卧位	2.26(1.48~3.46)	< 0.01	1.47(0.94~2.30)	0.09
	右侧卧位	2.18(1.42~3.34)	< 0.01	1.46(0.94~2.28)	0.10
书包重量	较轻	0.44(0.16~1.24)	0.12	0.54(0.19~1.51)	0.24
	较重	1.74(1.22~2.49)	< 0.01	1.36(0.93~1.99)	0.12
鞋底磨损情况(左右脚)	左脚更严重	2.25(1.30~3.91)	< 0.01	1.13(0.59~2.15)	0.71
	右损更严重	1.36(0.76~2.43)	0.30	0.78(0.40~1.51)	0.46
鞋底磨损情况(内外侧)	内侧更严重	2.05(1.08~3.86)	0.03	1.41(0.69~2.86)	0.34
	外侧更严重	1.81(1.21~2.70)	< 0.01	1.33(0.83~2.14)	0.23
肩、颈酸痛	有	1.55(1.05~2.28)	0.03	0.82(0.50~1.35)	0.44
高低肩	有	3.09(1.90~5.03)	< 0.01	1.62(0.92~2.83)	0.09
从未遇到上述健康问题	是	0.50(0.35~0.70)	< 0.01	0.81(0.51~1.28)	0.37
课外打篮球	参与	0.39(0.26~0.60)	< 0.01	0.70(0.44~1.13)	0.15
课外打乒乓球	参与	0.46(0.26~0.84)	0.01	0.80(0.43~1.51)	0.50
课外踢足球	参与	0.28(0.11~0.68)	< 0.01	0.42(0.17~1.06)	0.07
基本不参与体育锻炼	是	1.94(1.29~2.92)	0.01	0.98(0.62~1.54)	0.93

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参考文献(20)

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