Ho B C, Lee E H, Singh K
Department of Orthopaedic Surgery, National University Hospital, Singapore.
Singapore Med J. 1999 Nov;40(11):675-9.
Congenital muscular torticollis is a condition of debatable aetiology and management. Untreated, cervical function and facial cosmesis may be severely compromised. The aim of this study was to establish the epidemiology, presentation and management of congenital muscular torticollis in Singapore.
Ninety-one patients with torticollis were seen at the National University Hospital (NUH) from January 1994 to December 1997. Torticollis was first noted at a median age of 2 months with the median age of presentation being 6 months. At presentation, a sternomastoid tumour was noted in 33 patients and 62 patients had facial asymmetry. Thirteen of 22 patients with neonatal records available had mandibular hypoplasia at birth on the side where the sternomastoid was affected. Half of the patients (45) had a right sided lesion, with 46 being left sided. The rates of assisted breech delivery, instrumental deliveries (forceps and vacuum) and Caesarean section were higher in the study group. Nine (59.1%) of 13 patients with vertex presentation, had a lesion on the side of the presenting shoulder. Forty-eight of 72 patients responded well to therapy with improvement; 20 underwent surgery and the median age of presentation of 19.5 months in this group was significantly later than that of 4 months in the group which responded to physiotherapy alone.
Birth trauma appears to be the main aetiological factor in congenital muscular torticollis. Patients generally respond well to physiotherapy. This study revealed 2 findings hitherto unreported: (1) mandibular hypoplasia may be an useful early sign of this condition, and (2) the side affected may depend on the side of shoulder delivered first. More studies, however, are required to confirm these findings.
先天性肌性斜颈的病因和治疗存在争议。若不治疗，颈部功能和面部美观可能会受到严重影响。本研究的目的是确定新加坡先天性肌性斜颈的流行病学、临床表现及治疗方法。
1994年1月至1997年12月期间，国立大学医院（NUH）共诊治了91例斜颈患者。斜颈首次被发现的中位年龄为2个月，就诊的中位年龄为6个月。就诊时，33例患者发现有胸锁乳突肌肿块，62例患者存在面部不对称。在有新生儿记录的22例患者中，13例在胸锁乳突肌受累侧出生时存在下颌发育不全。一半的患者（45例）病变位于右侧，46例位于左侧。研究组中臀位助产、器械助产（产钳和真空吸引）及剖宫产的发生率较高。13例头先露的患者中有9例（59.1%）在先露肩侧有病变。72例患者中有48例对治疗反应良好，病情改善；20例接受了手术，该组就诊的中位年龄为19.5个月，明显晚于仅接受物理治疗组的4个月。
出生创伤似乎是先天性肌性斜颈的主要病因。患者通常对物理治疗反应良好。本研究揭示了两个此前未报道的发现：（1）下颌发育不全可能是该病有用的早期体征，（2）受累侧可能取决于先娩出的肩部侧别。然而，需要更多研究来证实这些发现。
