Do Twee T
Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
Curr Opin Pediatr. 2006 Feb;18(1):26-9. doi: 10.1097/01.mop.0000192520.48411.fa.
The purpose of this review is to better understand the spectrum of disease in torticollis, which is the third most common pediatric orthopaedic diagnosis in childhood. Besides the benign muscular tightness of the sternocleidomastoid muscle leading to the classic head position, the differential diagnosis of the wry neck include sequelae to inflammatory, ocular, neurologic or orthopedic diseases. Patients present with a stiff and tilted neck, and therefore require a thorough and systematic work-up, including a complete physical and neurologic examination and cervical spine radiographs.
Recent findings show that magnetic resonance imaging of the brain and neck is no longer considered cost-effective, or necessary, in congenital muscular torticollis. Observation and physical therapy, with or without bracing, is usually an effective treatment in most cases, especially if instituted within the first year of life. Botox has recently been shown to be an effective intermediate method of treatment for more resistant cases of congenital muscular torticollis. In those presenting after the age of 1 year, there is an increased rate of sternocleidomastoid muscle lengthening. The lengthening may improve the range of motion, but not necessarily the plagiocephaly, facial asymmetry, or cranial molding.
It is important to differentiate muscular from nonmuscular torticollis. Congenital muscular torticollis is benign; missing a case of nonmuscular torticollis could be potentially life threatening.
本综述的目的是更好地了解斜颈疾病的范围，斜颈是儿童期第三常见的小儿骨科诊断疾病。除了胸锁乳突肌良性肌肉紧张导致典型的头部姿势外，歪颈的鉴别诊断还包括炎症、眼部、神经或骨科疾病的后遗症。患者表现为颈部僵硬和倾斜，因此需要进行全面系统的检查，包括完整的体格检查和神经检查以及颈椎X光片。
最新发现表明，对于先天性肌性斜颈，脑部和颈部的磁共振成像不再被认为具有成本效益或必要。观察和物理治疗，无论是否使用支具，在大多数情况下通常都是有效的治疗方法，尤其是在出生后第一年内开始治疗。最近研究表明，肉毒杆菌毒素对于先天性肌性斜颈更难治的病例是一种有效的中间治疗方法。对于1岁以后就诊的患者，胸锁乳突肌延长的发生率增加。延长可能会改善活动范围，但不一定能改善扁头畸形、面部不对称或颅骨塑形。
区分肌性斜颈和非肌性斜颈很重要。先天性肌性斜颈是良性的；漏诊非肌性斜颈病例可能会危及生命。
