Daentzer Dorothea, Stüder Doris, Wirth Carl Joachim
Orthopädische Klinik der Medizinischen Hochschule Hannover, im Diakoniekrankenhaus Annastift.
Oper Orthop Traumatol. 2010 May;22(2):177-87. doi: 10.1007/s00064-010-8081-2.
Correction of malalignment of the cervical spine with the head tilted to the side of the shortened muscle and rotation to the opposite side due to a contract sternocleidomastoid muscle. Attainment of an increased range of motion of the cervical spine and a better cosmetic appearance. Regression of a facial asymmetry.
Contract sternocleidomastoid muscle with deformity intolerable by the patients and their parents.
Bony anomalies with consecutive torticollis. Torticollis caused by other muscular contractures (trapezoid muscle). Torticollis due to acute rheumatoid arthritis or other inflammation around the neck. Other forms of torticollis (psychogenic, ocular, vestibular or spasmodic torticollis).
In younger children, subcutaneous tenotomy of the distal part of the sternocleidomastoid muscle. At preschool age, additional incision of the deep cervical fascial layer with an open tenotomy. In delayed operations, open distal and proximal tenotomy together with incision of the deep fascial layer or complete excision of the sternocleidomastoid muscle.
Until the age of 6 years, application of a Minerva cast after surgery for 6 weeks. Subsequently, physical therapy for 6 months. In children of school age and older people, application of a soft cervical bandage for 6 weeks with functional physiotherapy.
In 83 reexamined patients with muscular torticollis, 76 biterminal and seven distal tenotomies had been performed. Regarding the age at the time of operation and the interval to follow-up, an improvement of facial symmetry could be achieved. At the control, 25 patients showed complete recovery of facial asymmetry, 43 had a slight and 15 a severe asymmetry. The complication rate was low with one injury to the external jugular vein and one transient facial nerve paresis. In two patients, passive overcorrection in the cast resulted in transient paresis. Two patients developed a recurrence of muscular torticollis.
矫正因胸锁乳突肌挛缩导致的颈椎排列不齐，表现为头部向患侧倾斜、向对侧旋转。增加颈椎活动范围，改善外观。减轻面部不对称。
患者及其家长无法忍受的胸锁乳突肌挛缩畸形。
伴有连续性斜颈的骨骼异常。由其他肌肉挛缩（斜方肌）引起的斜颈。急性类风湿性关节炎或颈部周围其他炎症导致的斜颈。其他形式的斜颈（精神性、眼性、前庭性或痉挛性斜颈）。
对于年幼儿童，行胸锁乳突肌远端皮下切断术。学龄前儿童，额外切开深层颈筋膜层行开放性切断术。对于延迟手术，行开放性远端和近端切断术并切开深层筋膜层或完全切除胸锁乳突肌。
6岁以下儿童，术后应用密涅瓦石膏固定6周。随后进行6个月的物理治疗。学龄儿童及成年人，应用软颈托6周并进行功能理疗。
在83例接受复查的肌性斜颈患者中，76例行双侧切断术，7例行远端切断术。就手术时的年龄和随访间隔而言，面部对称性得到改善。复查时，25例患者面部不对称完全恢复，43例轻度不对称，15例重度不对称。并发症发生率较低，1例颈外静脉损伤，1例短暂性面神经麻痹。2例患者因石膏固定时被动过度矫正导致短暂性麻痹。2例患者出现肌性斜颈复发。
