上海市中小学生脊柱侧弯筛查及影响因素分析

储莉婷; 张凤云; 齐文娟; 祁月; 杨军林; 王丽敏; 杨东玲; 罗春燕

doi:10.16835/j.cnki.1000-9817.2023.08.004

上海市中小学生脊柱侧弯筛查及影响因素分析

doi: 10.16835/j.cnki.1000-9817.2023.08.004

1.
上海市疾病预防控制中心儿童青少年健康所，200336
2.
上海交通大学医学院附属新华医院脊柱中心
3.
中国疾病预防控制中心慢性非传染性疾病预防控制中心监测室

基金项目: 中国儿童青少年脊柱侧弯流行病学调查项目

详细信息

作者简介:
储莉婷(1997-)，女，上海市人，硕士，医师，主要从事儿童青少年健康监测与干预方面工作

通讯作者:
杨东玲，E-mail: yangdongling@scdc.sh.cn

罗春燕，E-mail: luochunyan@scdc.sh.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R682.3 R179 R726.8
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出版历程
- 收稿日期: 2023-04-18
- 修回日期: 2023-05-05
- 网络出版日期: 2023-08-26
- 刊出日期: 2023-08-25

Screening for scoliosis and associated factors among primary and middle school students in Shanghai

1.
Institute of Child and Adolescent Health, Shanghai Municipal Center for Disease Control and Prevention, Shanghai (200336), China

摘要

摘要: 结论了解上海市中小学生脊柱侧弯的发生情况及影响因素，为制定儿童青少年脊柱侧弯防控策略和措施提供数据支持。方法于2021年9—12月，采用多阶段分层整群抽样方法抽取上海市4个区16所中小学4 531名四年级至初三年级学生，开展脊柱侧弯筛查和问卷调查。采用独立样本t检验、χ²检验、Fisher确切概率法和非参数Mann-Whitney U检验进行统计学分析，使用多因素Logistic回归分析脊柱侧弯的影响因素。结果脊柱侧弯的现场检出率为7.4%，患病率为2.2%，侧弯部位胸腰段占比最高(60.4%)，侧弯角度10°~< 20°占比最高(88.1%)。男生脊柱侧弯检出率为1.6%，女生为3.3%，差异有统计学意义(χ²=11.84，P < 0.01)；脊柱侧弯学生与初筛阴性学生体重、体质量指数(BMI)差异均有统计学意义(t值分别为-3.77，-5.30，P值均 < 0.01)；不同班级座位调换频率中小学生脊柱侧弯检出率差异有统计学意义(Z=2.02，P < 0.05)。多因素Logistic回归分析结果显示，女生发生脊柱侧弯的风险高于男生(OR=1.87, 95%CI=1.21~2.88)，BMI、班级座位调换均与脊柱侧弯呈负相关；男生班级座位调换与脊柱侧弯呈负相关(OR=0.26, 95%CI=0.10~0.67)；女生学段与脊柱侧弯呈正相关(OR=2.35, 95%CI=1.26~4.41)，BMI与脊柱侧弯呈负相关(OR=0.86, 95%CI=0.79~0.94)(P值均 < 0.05)。结论脊柱侧弯定期筛查是有效的早期发现方法，初中、低BMI的女生可作为密切关注对象。根据脊柱侧弯的发生情况和影响因素，可开展基于家庭、学校、社会等多方面的综合防控。
- 脊柱侧凸 /
- 问卷调查 /
- 患病率 /
- 回归分析 /
- 学生
Abstract: Objective To understand the prevalence and influencing factors of scoliosis among primary and middle school students in Shanghai, so as to provide reference for the prevention and control strategies of scoliosis in children and adolescents. Methods From September to December 2021, a total of 4 531 students from grade four of primary school to grade three of junior high school from 16 primary and middle schools in 4 districts of Shanghai were selected by multi-stage stratified cluster sampling to carry out scoliosis screening and questionnaire survey. Independent sample t-test, Chi-squared test, Fisher's exact probability method and nonparametric Mann Whitney U-test were used for statistical analysis, and multivariate Logistic regression was used to analyze the influencing factors of scoliosis. Results The on-the-spot detection rate of scoliosis abnormality was 7.4% and the prevalence was 2.2%, mainly for thoracolumbar scoliosis (60.4%) and the scoliosis angle of 10° - < 20°(88.1%). The results showed that the detection rate of scoliosis in boys was 1.6% and in girls was 3.3%, with a statistically significant difference (χ²=11.84, P < 0.01). There were significant differences in weight and BMI between scoliosis students and students with negative initial screening(t=-3.77, -5.30, P < 0.01). And there was a statistically significant difference in the detection rate of scoliosis with different frequency of classroom seating arrangements (Z=2.02, P < 0.05). The results of multivariate Logistic regression showed that the risk of scoliosis in girls was higher than that in boys (OR=1.87, 95%CI=1.21-2.88). BMI (OR=0.89, 95%CI=0.83-0.95) and frequency of classroom seating arrangements (OR=0.49, 95%CI=0.25-0.93) were correlated with lower rate of scoliosis. After stratification by sex, the frequency of classroom seating arrangements (OR=0.26, 95%CI=0.10-0.67) in boys and the educational stage (OR=2.35, 95%CI=1.26-4.41) in girls (P < 0.05) was correlated with higher rate of scoliosis, while BMI (OR=0.86, 95%CI=0.79-0.94) in girls were correlated with lower rate of scoliosis. Conclusion Regular screening of scoliosis is an effective method for early detection of scoliosis. Girls in junior high school and low BMI should be paid close attention to. According to the occurrence and influencing factors of scoliosis, comprehensive prevention and control based on family, school, society, and other aspects can be carried out.
- Scoliosis /
- Questionnaires /
- Prevalence /
- Regression analysis /
- Students
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 不同性别年级脊柱侧弯学生侧弯部位和角度分布比较

Table 1. Comparison of scoliosis location and angle distribution of scoliosis students among different genders and grades

性别与年级		人数	部位					角度
性别与年级		人数	胸段	胸腰段	腰段	胸腰双凸	P值	10°~< 20°	20°~< 30°	30°~< 40°	40°~< 50°	P值
性别	男	36	6(16.7)	24(66.7)	1(2.8)	5(13.9)	0.36^*	34(94.4)	2(5.6)	0	0	0.31^*
	女	65	17(26.2)	37(56.9)	0	11(16.9)		55(84.6)	8(12.3)	0	2(3.1)
年级	四	16	3(18.8)	11(68.8)	0	2(12.5)	0.17^*	16(100.0)	0	0	0	0.50^*
	五	17	1(5.9)	13(76.5)	0	3(17.6)		15(88.2)	2(11.8)	0	0
	六	15	2(13.3)	10(66.7)	0	3(20.0)		13(86.7)	2(13.3)	0	0
	初一	24	4(16.7)	15(62.5)	0	5(20.8)		22(91.7)	1(4.2)	0	1(4.2)
	初二	16	8(50.0)	6(37.5)	1(6.2)	1(6.3)		12(75.0)	3(18.8)	0	1(6.2)
	初三	13	5(38.5)	6(46.2)	0	2(15.4)		11(84.6)	2(15.4)	0	0
注：()内数字为构成比/%；* Fisher确切概率法。

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表 2 中小学生脊柱侧弯影响因素的单因素分析

Table 2. Univariate analysis of influencing factors in scoliosis among primary and secondary school students

因素	选项	男生				女生				总体
因素	选项	人数	脊柱侧弯	χ²/Z值	P值	人数	脊柱侧弯	χ²/Z值	P值	人数	脊柱侧弯	χ²/Z值	P值
学段	四至六	1 112	22(2.0)	1.61	0.21	1 057	26(2.5)	4.76	0.03	2 169	48(2.2)	0.79	0.37
	初一至初三	1 084	14(1.3)			927	39(4.2)			2 011	53(2.6)
主要照护者^*	父母	1 923	34(1.8)	0.40	0.53	1 778	59(3.3)	0.01	0.92	3 701	93(2.5)	0.30	0.58
	非父母	216	2(0.9)			173	6(3.5)			389	8(2.1)
照护者文化水平^*	初中及以下	375	11(2.9)		0.12^a	313	13(4.2)	0.81	0.85	688	24(3.5)	4.12	0.25
	高中/中专/技校	409	4(1.0)			382	12(3.1)			791	16(2.0)
	大专/本科	1 247	21(1.7)			1 140	36(3.2)			2 387	57(2.4)
	硕士及以上	108	0			116	4(3.4)			224	4(1.8)
医疗保险^*	是	1 958	30(1.5)	1.30	0.26	1 838	62(3.4)	0.00	>0.99	3 796	92(2.4)	0.96	0.33
	否	120	4(3.3)			78	3(3.8)			198	7(3.5)
家庭年收入/万元^*	< 10	96	0		0.58^a	74	1(1.4)		0.63^a	170	1(0.6)		0.23^a
	10~< 30	221	4(1.8)			216	9(4.2)			437	13(3.0)
	≥30	208	2(1.0)			179	6(3.4)			387	8(2.1)
父母脊柱侧弯史^*	是	20	0		>0.99^a	32	3(9.4)	2.03	0.15	52	3(5.8)	1.20	0.27
	否	2 119	36(1.7)			1 919	62(3.2)			4 038	98(2.4)
日常中高强度体力活动^*	是	2 044	35(1.7)		0.73^a	1 799	61(3.4)	0.19	0.66	3 843	96(2.5)	0.54	0.46
	否	139	1(0.7)			165	4(2.4)			304	5(1.6)
校内每周体育锻炼频率/d^*	0~< 3	192	3(1.6)	0.10	0.92	213	5(2.3)	0.83	0.41	405	8(2.0)	0.63	0.53
	≥3	1 991	33(1.7)			1 751	60(3.4)			3 742	93(2.5)
校外每周体育锻炼频率/d^*	0~< 3	733	11(1.5)	0.39	0.70	819	31(3.8)	1.00	0.32	1 552	42(2.7)	0.87	0.38
	≥3	1 450	25(1.7)			1 145	34(3.0)			2 595	59(2.3)
学习日22:00后睡觉^*	是	87	2(2.3)	0.01	0.94	92	1(1.1)		0.37^a	179	3(1.7)	0.18	0.68
	否	2 078	33(1.6)			1 862	64(3.4)			3 940	97(2.5)
休息日22:00后睡觉^*	是	108	1(0.9)		>0.99^a	96	2(2.1)	0.17	0.68	204	3(1.5)	0.50	0.48
	否	2 053	35(1.7)			1 850	63(3.4)			3 903	98(2.5)
每周奶及奶制品摄入/次^*	< 1	178	2(1.1)	0.07	0.95	142	3(2.1)	0.03	0.97	320	5(1.6)	0.16	0.87
	1~< 7	284	6(2.1)			325	13(4.0)			609	19(3.1)
	≥7	1 723	28(1.6)			1 499	49(3.3)			3 222	77(2.4)
每周水产品摄入/次^*	< 1	575	10(1.7)	0.36	0.72	460	17(3.7)	0.25	0.80	1 035	27(2.6)	0.04	0.97
	1~< 7	937	16(1.7)			964	27(2.8)			1 901	43(2.3)
	≥7	673	10(1.5)			542	21(3.9)			1 215	31(2.6)
每周碳酸饮料摄入/次^*	< 1	1 298	18(1.4)	0.75	0.46	1 271	39(3.1)	0.69	0.49	2 569	57(2.2)	0.77	0.44
	1~< 7	601	15(2.5)			534	21(3.9)			1 135	36(3.2)
	≥7	286	3(1.0)			161	5(3.1)			447	8(1.8)
每周蛋类摄入/次^*	< 1	155	3(1.9)	2.04	0.04	155	4(2.6)	0.72	0.47	310	7(2.3)	1.92	0.06
	1~< 7	464	13(2.8)			471	20(4.2)			935	33(3.5)
	≥7	1 566	20(1.3)			1 340	41(3.1)			2 906	61(2.1)
每周复合补充剂摄入/次^*	< 1	1 376	22(1.6)	0.46	0.64	1 253	49(3.9)	1.82	0.07	2 629	71(2.7)	1.21	0.23
	1~< 7	223	2(0.9)			237	4(1.7)			460	6(1.3)
	≥7	586	12(2.0)			476	12(2.5)			1 062	24(2.3)
每周外卖频率/次^*	< 1	1 698	28(1.6)	0.07	0.94	1 544	55(3.6)	1.28	0.20	3 242	83(2.6)	1.09	0.28
	1~< 7	384	7(1.8)			335	9(2.7)			719	16(2.2)
	≥7	103	1(1.0)			87	1(1.1)			190	2(1.1)
班级座位调换^*	是	2 061	30(1.5)	7.78	0.01	1 839	60(3.3)	0.01	0.93	3 900	90(2.3)	3.86	0.05
	否	128	6(4.7)			131	5(3.8)			259	11(4.2)
班级座位调换频率^*	从不	128	6(4.7)	0.94	0.35	131	5(3.8)	1.65	0.10	259	11(4.2)	2.02	0.04
	1学期1次	122	1(0.8)			150	7(4.7)			272	8(2.9)
	1个月1次	100	2(2.0)			84	3(3.6)			184	5(2.7)
	2周1次	350	4(1.1)			314	14(4.5)			664	18(2.7)
	每周1次	1 489	23(1.5)			1 291	36(2.8)			2 780	59(2.1)
课桌椅高度根据身高调整^*	是	1 172	16(1.4)	1.22	0.27	999	29(2.9)	1.00	0.32	2 171	45(2.1)	2.43	0.12
	否	1 017	20(2.0)			971	36(3.7)			1 988	56(2.8)
课桌椅高度根据身高调整频率^*	从不或不可调	1 017	20(2.0)	1.53	0.13	971	36(3.7)	0.99	0.32	1 988	56(2.8)	1.81	0.07
	1学年1次	170	5(2.9)			166	5(3.0)			336	10(3.0)
	1学期≥1次	1 002	11(1.1)			833	24(2.9)			1 835	35(1.9)
课桌相对桌椅高度合适^*	是	1 982	32(1.6)	0.00	0.97	1 749	57(3.3)	0.07	0.80	3 731	89(2.4)	0.25	0.62
	否	209	4(1.9)			223	8(3.6)			432	12(2.8)
注：()内数字为检出率/%；*表示存在缺失值；a表示Fisher确切概率法。

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表 3 中小学生脊柱侧弯影响因素多因素分析

Table 3. Multivariate analysis of influencing factors in scoliosis among primary and secondary school students

自变量	男生(n=2 196)		女生(n=1 984)		总体(n=4 180)
自变量	OR值(95%CI)	P值	OR值(95%CI))	P值	OR值(95%CI))	P值
性别
男	-	-	-	-	1.00
女	-	-	-	-	1.87(1.21~2.88)	< 0.01
学段
四至六	1.00		1.00		1.00
初一至初三	0.83(0.37~1.90)	0.67	2.35(1.26~4.41)	0.01	1.63(0.99~2.66)	0.05
BMI	0.93(0.84~1.02)	0.11	0.86(0.79~0.94)	0.01	0.89(0.83~0.95)	< 0.01
班级座位调换
否	1.00		1.00		1.00
是	0.26(0.10~0.67)	0.01	0.78(0.31~2.01)	0.61	0.49(0.25~0.93)	0.03
注：BMI、每日睡眠时间为连续性变量。

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