2124例婴儿斜颈首诊的临床流行病学分析

Infantile Torticollis： A prospective clinical epidemiological study of 2124 cases

目的探讨1岁以内斜颈患儿的临床流行病学特征。方法设计门诊首诊斜颈患儿就诊表格，对年龄小于1岁的斜颈患儿，收集并分析其首诊年龄、颈部歪斜方向、是否早产、胎位、产式（剖腹产、难产、顺产）、胎次、及是否伴有下肢外展阳性等。结果2003年11月至2011年9月，本院共2124例年龄小于1岁的斜颈患儿就诊，根据颈部肿块史、临床体检和超声检查，分为先天性肌性斜颈（Congential Muscular Torticollis，CMT）组和姿势性斜颈（Posture Torticollis，PT）组，对两组患儿的患侧分布、胎位不正、难产、早产、第2胎、伴下肢外展阳性等观察指标进行比较，结果显示差异均有统计学意义（P〈0．05或0．01）。结论CMT以右侧稍多，盯以左侧稍多；年龄小的患儿应注意CMT的排查。CMT患儿多有胎位不正、难产史；患儿为早产或第2胎者发生CMT相对少。因此，胎位和分娩异常可能与CMT发病相关。有包块的CMT更易伴有下肢外展阳性，应注意排查DDH。

Objetive The aim of this epidemiological study was to investigate the clinical epidemiologic features of infantile torticoUis. Methods Selected the children with torticollis were less than 1 year old and divided into two groups, one group with congenital muscular torticollis（CMT） and another group with postural torticoUis（PT）. The study was prospectively designed a form in which the first diagnosed age, neck-skew di- rection, preterm delivery, fetal position, parturition way（ abdominal delivery, dystocia ,eutocia）, fetus order and Ortolani sign were recorded. Results The difference of the first diagnosed age, neck - skew direction, abnormal fetal positions, dystocia, preterm delivery, second fetus and Ortolani sign-positive between the two groups were statistically significant （P 〈0. 05 or P 〈0. 01）. Conclusion In CMT, patients with right＂ side was a little more than left, then in PT patients with left side was more than patients with right side. The body weight was no difference between the two groups. The more abnormal fetal positions and dystocia were found in CMT than in PT. Compared to CMT group, more cases with preterm and second birth was found in PT group. It was infer that abnormal fetal position and abnormal delivery may be related to pathoetiology of CMT. The in- cidence of DDH is higher in CMT than in PT, so Ortolani sign should be checked in children with CMT for ex- cluding DDH.