Macé Y, Yahia M, Rannou F, Lefevre-Colau M M, Poiraudeau S, Revel M
Service de rééducation et de réadaptation de l'appareil locomoteur et des pathologies du rachis, hôpital Cochin, université Paris-V, France.
Ann Readapt Med Phys. 2005 May;48(4):207-11. doi: 10.1016/j.annrmp.2004.12.002.
To point out the diagnostic and etiologic context of neck extensor weakness and to consider orthopedic and rehabilitation treatment of dropped head syndrome.
We report a case of a 68-year-old hospitalized woman with atypical and serious idiopathic neck extensor weakness who was treated by orthopedic measurements and intensive rehabilitation.
Our patient had progressive neck extensor weakness and total inflection of the cervico-cephalic axis over two years. Fixed and permanent contact of the chin and the sternum severely affected her ability to eat, and mandibular and sternal pressure ulcers developed. Cervical spine radiography revealed degenerative lesions. Other clinical and biological parameters were normal. Atypical idiopathic head drop was diagnosed because of painful and fixed head position. Rehabilitation consisted of cervical traction with a halo apparatus during eight weeks and an exercise programme based on cervical proprioception and muscular work. Orthopedic management consisted of cervical collar immobilization after cutaneous cicatrization. After ten weeks of treatment, the patient was able to raise her head and maintain it horizontally. Two years later, clinical results were stable.
Neck extensor weakness may be the presenting feature of several neuromuscular disorders. Generally, idiopathic dropped head syndrome appears to be the most likely diagnosis in patients with isolated neck extensor involvement. For our patient, clinical findings and cervical computed tomography showed important muscular weakness. However, painful passive extension and progressive stiffness of the neck do not represent the typical clinical course of idiopathic head drop. Neither degenerative lesions of the cervical spine nor other joint diseases can cause head drop. This case may result from the combined effects of idiopathic dropped head syndrome and cervical arthrosis. Orthopedic treatment and intensive rehabilitation had spectacular effects. Clinical management of head drop syndrome should always consist of orthopedic and rehabilitation treatment.
指出颈部伸肌无力的诊断和病因背景，并探讨低头综合征的骨科及康复治疗方法。
我们报告了一例68岁住院女性患者，患有非典型且严重的特发性颈部伸肌无力，接受了骨科治疗措施及强化康复治疗。
我们的患者在两年内出现进行性颈部伸肌无力及颈-头轴完全屈曲。下巴与胸骨固定性永久接触严重影响其进食能力，并出现下颌及胸骨压力性溃疡。颈椎X线检查显示有退行性病变。其他临床及生物学参数均正常。因头部位置疼痛且固定，诊断为非典型特发性低头症。康复治疗包括使用头环装置进行为期八周的颈椎牵引，以及基于颈部本体感觉和肌肉锻炼的运动计划。骨科处理包括在皮肤瘢痕形成后使用颈托固定。经过十周治疗，患者能够抬头并保持水平姿势。两年后，临床效果稳定。
颈部伸肌无力可能是多种神经肌肉疾病的表现特征。一般来说，特发性低头综合征似乎是孤立性颈部伸肌受累患者最可能的诊断。对于我们的患者，临床检查结果及颈椎计算机断层扫描显示有明显的肌肉无力。然而，颈部被动伸展时疼痛及逐渐僵硬并不代表特发性低头症的典型临床病程。颈椎退行性病变及其他关节疾病均不会导致低头症。该病例可能是特发性低头综合征与颈椎病共同作用的结果。骨科治疗及强化康复产生了显著效果。低头综合征的临床处理应始终包括骨科及康复治疗。
