120例先天性肌性斜颈术后的长期随访

Long-term Follow-up of Surgical Treatment for Congenital Muscular Torticollis, 120 Cases Report

目的 通过长期随访手术治疗先天性肌性斜颈的疗效,探讨最佳手术时机及影响疗效的因素.方法 手术治疗120例先天性肌性斜颈患儿,手术时年龄为3～142个月,平均随访4.9年（2～12.5年）,按年龄、术前是否曾行理疗及术式进行分组,根据改良Cheng and Tang疗效评分标准,使用头颈部旋转角、侧屈角、瘢痕、颅面部畸形、肌束情况、头斜及主观评价等指标评估其疗效.结果 总评分为优79例（65.8%）,良37例（30.9%）,中1例（0.8%）,差3例（2.5%）,优良率为96.7%.按生长发育特点分为Ⅰ组（≤1岁）、Ⅱ组（1～3岁）、Ⅲ组（＞3岁）,之后对各指标优率进行x2检验,在瘢痕评分方面无统计学差异（P＞0.05）;但在总评分、旋转角、侧屈角、头斜及肌束挛缩方面,Ⅰ组和Ⅱ组分别与Ⅲ组比较,P＜0.05,提示3岁以内优率更高;在颅面部畸形方面,Ⅱ组和Ⅲ组分别与Ⅰ组比较,P＜0.05,提示1岁以内优率更高;在医生的主观评价方面,3组之间相互比较,P＜0.05,提示年龄越小,优率越高.结论 先天性肌性斜颈3岁以内手术能够获得较好的手术疗效,1岁以内手术疗效最佳.对于1岁以内接受正规理疗6个月无明显效果者应及早手术治疗.

Objetive To compare the surgical treatment for congenital muscular torticollis （CMT） for more than two years to follow-up and the curative effect in different groups, so as to find out the influence fac- tom on the optimal timing of surgery for the disease. Methods One hundren and twenty patients with congeni- tal muscular tortieollis, age ranged from 3 to 142 months （ average 25.1 ） , underwent surgical releases of the contractive bands and were followed-up for more than two years （ ranged from 2 to 12.5 years with average 4.9 years） in Shenzhen Children~ Hospital. All of the patients were grouped by age, preoperative physical therapy and surgical procedures. Aceording to the characteristics of ehild growth and development, patients were divided to three age groups, i. e. Group I with 1 year or less, Group I1 l to 3 years old and Group I11 more than 3 years. According to whether patient treated by physieal therapy before operation, the patient were divided to physieal therapy group and non-physical therapy group. According to surgieal procedure, the patients were divided to u- nipolar reseetion group and bipolar resection group.. The overall clinical outcome were assessed by using the Cheng and Tang＇s score table, in which rotational defieits, lateral bending defieits, eraniofacial asymmetry, scar, band, subjective assessment, and head tilt were ineluded. The differences between eaeh two groups were evaluated with chi-square and analysis of variance. The value of P 〈 0.05 was considered statistically signifi- cant. Results Aceording to overall scores for overall outcome ,there were 79 eases with excellent （65.8%） , 37 with good（30.9% ）, 1 with fair（0.8% ） and 3 with poor（2.5% ） . The cxeellent and good results were as high as 96.7%. No significant differenee of sear scoring were found in the age groups（ P 〉 0. 05 ）. However, statistical significant difference of head tilt, rotational defieits, lateral bending deficits, band and overall elinical outcome were found between age group I and III and between age group II and llI. The results indicates that more excellent outcome cases were found in age group I and II. The eraniofacial asymmetry appearance was cosmetically improved more well in age group I than in group II and III （ P 〈 0. 05 ）. For the subjective as- sessment by doctors, the more excellent cases were found in group I than in other two groups. In addition, more excellent cases were found in physical therapy group than in non - physical therapy group and in bipolar resec- tion group than in unipolar resection group respectively. Conclusions The surgical treatment for patient with congenital muscular torticollis are more efficacious if the age of patient is under 3 years old especially under 1 year. For the patients age under one year, surgery should be considered if the manual stretching treatment for six months is poor.