目的探讨学龄儿童握笔姿势和握力与近视的相关性。
方法采用横断面研究方法，连续纳入2021年11月至2022年5月在深圳市眼科医院行视力检查的496例1～6年级学龄儿童，收集受检儿童年龄、年级、性别、屈光度，入学年龄。分别使用电子握力计和工具笔获取其握力及握笔姿势情况，并根据握笔姿势分为握笔姿势规范组和握笔姿势不规范组。采用最邻近匹配法对握笔姿势规范组和握笔姿势不规范组性别、年级、入学年龄、握力进行倾向性评分匹配。以双眼近视、单眼近视和正视为因变量，握力、年级、屈光参差、握笔姿势等作为自变量进行多因素二分类Logistic回归分析。采用Spearman秩相关分析和偏相关分析探索握力与等效球镜度的相关性。
结果倾向性评分匹配后，获得握笔姿势规范组101例，握笔姿势不规范组197例，各组间性别、年级、入学年龄、握力比较，差异均无统计学意义(均 P>0.05)。多分类Logistic回归结果显示，以正视作为参照，高年级[4VS1∶7.601(1.307～44.206)；5VS1∶4.392(1.039～18.562)]、存在屈光参差[21.366(5.750－79.397)]为单眼近视的相对危险因素(均 P<0.05)，高年级[3VS1∶4.389(1.783～10.800)；4VS1∶15.398(3.267～72.574)；5VS1∶7.447(2.232～24.851)；6VS1∶6.462(2.116～19.734)]为双眼近视的相对危险因素(均 P<0.05)。以单眼近视作为参照，高年级[6VS1∶4.582(1.193～17.589)]、存在屈光参差[0.141(0.069～0.289)]、不规范握笔姿势[2.608(1.340～5.075)]为双眼近视的相关因素(均 P<0.05)。偏相关分析结果显示，握笔姿势不规范组右眼等效球镜度与握力大小呈负相关( r s＝－0.141， P＝0.047)。
结论握笔姿势不规范与学龄儿童近视具有相关性。握笔姿势不规范且握力较大的儿童，可能存在更高度数的右眼近视。
ObjectiveTo investigate the correlation between pen-holding posture, grip strength and myopia.
MethodsA cross-sectional study was performed.A total of 496 school-aged children in grades 1-6, who underwent eye examinations at Shenzhen Eye Hospital from November 2021 to May 2022 were consecutively enrolled as subjects.The subjects' age, grade, sex, refractive error and age of school enrollment were recorded.Subjects' grip strength and pen-holding posture were obtained with an electronic grip strength meter and a tool pen, and subjects were divided into correct pen-holding posture group and incorrect pen-holding posture group according to their pen-holding posture.Propensity scores for sex, grade, age at school entry, and grip strength in the two groups were matched using the nearest neighbor matching method.Multifactorial binary logistic regression analysis was performed with binocular myopia, monocular myopia, and emmetropia as dependent variables and grip strength, grade, refractive error, and pen-holding posture as independent variables.The correlation between grip strength and spherical equivalent was examined by Spearman rank correlation analysis and partial correlation analysis.This study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Shenzhen Eye Hospital (No.2022KYPJ032).
ResultsAfter matching propensity scores, there were 101 cases and 197 cases in the correct pen-holding posture group and incorrect pen-holding posture group, respectively.There was no statistical significance in sex, grade, age at enrollment, and grip strength between the two groups (all at P>0.05).Multinomial logistic regression results showed that using emmetropia as a reference, higher grade (4 versus 1∶7.601[1.307-44.206]; 5 versus 1∶4.392[1.039-18.562]), presence of anisometropia (21.366[5.750-79.397]) were relative risk factors for monocular myopia (all at P<0.05), and higher grade (3 versus 1∶4.389[1.783-10.800]); 4 versus 1∶15.398[3.267-72.574]; 5 versus 1∶7.447[2.232-24.851]; 6 versus 1∶6.462[2.116-19.734]) were relative risk factors for binocular myopia (all at P<0.05).Taking monocular myopia as a reference, higher grade (6 versus 1∶4.582[1.193-17.589]), presence of anisometropia (0.141[0.069-0.289]), and irregular pen-holding posture (2.608[1.340-5.075]) were associated factors for binocular myopia (all at P<0.05).According to partial correlation analysis, the spherical equivalent of the right eye of children with incorrect pen-holding posture was negatively correlated with the grip strength ( r s=-0.141, P=0.047).
ConclusionsThere is an association between pen-holding posture and myopia in school-aged children.Children with greater grip strength and incorrect pen-holding posture may have higher degrees of right eye refractive error.
吴雨骁,陶政旸,徐志容,等. 学龄儿童握笔姿势及握力与近视的相关性研究[J]. 中华实验眼科杂志,2024,42(09)：827-833.
DOI:10.3760/cma.j.cn115989-20220929-00462版权归中华医学会所有。
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