婴儿先天性肌性斜颈保守综合治疗1142例  

Comprehensive treatment of infants with congenital muscular torticollis:a report of 1142 cases

作　　者：赵章帅[1] 唐盛平[1] 熊竹[2] 

机构地区：[1]遵义医学院珠海校区,广东省珠海市519041 [2]深圳市儿童医院外一科,广东省深圳市518038

出　　处：《临床小儿外科杂志》2016年第6期551-557,共7页Journal of Clinical Pediatric Surgery

基　　金：深圳市科学创新委员会资助项目(JCYJ20130401114111461)

摘　　要：目的分析和评估婴儿先天性肌性斜颈(congential muscular torticollis,CMT)综合治疗疗效和影响疗效的相关因素。方法对确诊为先天性肌性斜颈婴儿采取手法牵拉、按摩包块、超声短波理疗相结合的治疗方法,并根据患儿的恢复情况辅以局部注射糖皮质激素,按改良Cheng^([1])评估治疗的疗效,分析影响疗效的相关因素。结果 1 142例患儿中,男性684例,女性458例,最短随访时间1年,最长9年,平均为3.14年。有103例(占9.03%)最终行手术治疗,有效率90.97%。影响最终疗效的相关因素是有无肿块(P=0.049)、是否拉断(P<0.001)、初诊年龄(P<0.001)、旋转受限度数(尸<0.001)和性别(P=0.038);物理治疗中发生拉断(Give-way)患儿与初诊年龄(P<0.001)、是否难产(P=0.011)有关联;根据有肿块(P=0.044)、是否拉断(P=0.005)、初诊年龄(P<0.001)和旋转受限程度(P<0.001)分组后各组的手术率差异有统计学意义。结论手法牵拉、按摩包块、超声短波理疗三种相结合的方法治疗CMT,并根据患儿恢复情况辅以局部注射糖皮质激素的综合疗法,对于CMT患儿是一种安全、有效的方法。Objective To explore the comprehensive treatment outcomes of infants with congenital mus- cular tortieollis （CMT） and analyze the influencing factors of its efficacy for optimized treatment. Methods A total of 1,142 infants were initially diagnosed as CMT. According to medical history, clinical signs and neck ultrasonography, they were divided into lump and ultrasound groups. The lump group included patients with a history of lump occurrence, palpable lump and ultrasonic sternocleidomastoid thickening or lump. And the ultrasound group included those without a history of lump occurrence, uncertain palpation lump yet ultrasonic sternocleidomastoid thickening. All patients received standard outpatient measures of manual stretching, lump massage and short-wave ultrasonic physiotherapy. Also local glucocorticoid injection was provided for sternoclei- domastoid tumor. The follow-up period was at least 1 year and regular follow-up results were also analyzed ac- cording to the relevant factors. Curative efficacy was assessed after treatment. Results The curative ratio of comprehensive treatment was 90.97% and only 103 （ 9.03% ） cases were operated. Follow-ups of 1 142 （83.2%） cases showed that 988 （86.5%） cases fared excellent ＆ good, 51 （3.1%） fair and 103 （ 10.4% ） poor. Statistical analysis showed that： a） significant relevance existed between curative efficacy and such factors as lump （ P = 0. 049 ）, give-way （ P 〈 0. 001 ）, initial diagnosis age （ P 〈 0. 001 ）, rotation deficit （ P 〈 0. 001 ） and gender（P = 0. 038） ; b） Patients with sudden giving-way or snapping of sternomastoid was signifi- cantly associated with initial diagnosis age（ P 〈0. 001 ） and dystocia（ P =0.011 ） ; c） Patients treated by glu- cocorticoid injection were significantly associated with initial diagnosis age （ P 〈 0. 001 ）, rotation deficit （ P 〈 0. 001 ）, male（ P = 0. 018 ）, left sideness （ P 〈 0. 001 ）, fetal malposition （ P = 0. 029 ） and eutocia

关 键 词：斜颈/先天性 综合疗法 婴儿 

分 类 号：R726.5[医药卫生—儿科]