关节镜下双极电极松解治疗儿童先天性肌性斜颈的优势及应用价值  

Arthroscopically assisted radiofrequency tenotomy for congenital muscular torticollis in children

作　　者：李海艟 李浩[1] 郭东[1] 曹隽[1] 姚子明 祁新禹[1] 刘虎[1] 张学军[1] Li Haichong;Li Hao;Guo Dong;Cao Jun;Yao Ziming;Qi Xinyu;Liu Hu;Zhang Xuejun(Department of Orthopedic,Affiliated Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院骨科,北京100045

出　　处：《临床小儿外科杂志》2024年第7期648-652,共5页Journal of Clinical Pediatric Surgery

基　　金：北京市自然科学基金(L222095)。

摘　　要：目的探讨关节镜下双极电极松解治疗儿童先天性肌性斜颈(congenital muscular torticollis,CMT)的优势及应用价值。方法回顾性分析2019年6月至2022年6月首都医科大学附属北京儿童医院骨科收治的CMT患儿资料。根据美国儿童肌性斜颈临床实践指南,术前对入组患儿进行严重程度分级。根据手术方式的不同,将患儿分为关节镜下双极电极松解组及开放手术组。分别于术后1周、1个月、3个月以及1年进行门诊复查,并利用Cheng评分进行临床疗效判定。结果本研究共纳入CMT患儿83例,严重程度分级:8级82例、7级1例。关节镜下双极电极松解组共46例,开放手术组共37例,两组患儿性别比例、手术年龄、病史时间、术前严重程度分级比较,差异均无统计学意义(P>0.05)。关节镜下双极电极松解组的手术时间长于开放手术组[(62.5±17.9)min比(47.6±14.4)min,P<0.001];关节镜下双极电极松解组的切口长度[(0.5±0.0)cm比(3.5±0.7)cm]及术后住院时间[(2.3±1.1)d比(3.6±1.6)d]均短于开放手术组,差异均有统计学意义(P<0.05)。两组术后随访(1.8±1.0)年,Cheng评分等级:优秀80例,良好3例。两组术后各有2例出现皮下积液,并发症发生率及Cheng评分差异均无统计学意义(P>0.05)。结论关节镜下双极电极松解治疗儿童CMT虽较传统切开手术延长了手术时间,但术中视野清晰,伤口隐蔽,手术损伤小,患儿恢复快,手术疗效满意。Objective To discuss the advantage of arthroscopically assisted radiofrequency tenotomy of sternocleidomastoid muscle for congenital muscular torticollis(CMT)in children.Methods From June 2019 to June 2022,the relevant clinical data were retrospectively reviewed for 83 CMT children.According to the 2018 American Physical Therapy Association’s clinical practice guidelines of children with muscular torticollis,disease severity was graded pre-operation.Based upon specific operations,they were assigned into two groups of arthroscopiclly assisted radiofrequency tenotomy(n=46)and open operation(n=37).Outpatient re-examinations were performed at Week 1 and Month 1/3 post-operation.Postoperative follow-ups were conducted with Cheng’s scoring system.Results Clinical grades wereⅧ(n=82)andⅦ(n=1).No significant inter-group differences existed in gender ratio,operative age,medical history or preoperative severity.Operative duration of radiofrequency tenotomy group was longer than that of open operation group.Incision length and postoperative hospitalization stay were significantly shorter in radiofrequency tenotomy group than those in open operation group and(3.3±1.1)vs.(3.6±1.6)day,P<0.001.During an average follow-up period of(1.8±1.0)years,Cheng’s score was excellent(n=80)and decent(n=3).Two cases of subcutaneous effusion occurred in each group.No inter-group difference existed in complication rate or Cheng’s score.Conclusions Operative duration of radiofrequency tenotomy of CMT is longer than that of open operation.Arthroscopically assisted radiofrequency therapy for CMT offers the advantages of safety,mini-invasiveness and satisfactory efficacy.

关 键 词：关节镜 双极电极 外科手术 儿童 

分 类 号：R68[医药卫生—骨科学]