指南：美国神经外科学会系统评价和基于证据的指南：姿势性斜头畸形患者的管理：重新定位的作用。

Guidelines: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning.

机构信息

*Semmes-Murphey Neurologic & Spine Institute; Department of Neurosurgery, University of Tennessee Health Science Center; Le Bonheur Children's Hospital, Memphis, Tennessee; ‡University of Tennessee Health Science Center, Memphis, Tennessee; §Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; ¶Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; ‖Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida; #Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; **St. Louis Cleft-Craniofacial Center, SSM Health Cardinal Glennon Children's Hospital at Saint Louis University, Division of Plastic Surgery, Saint Louis University School of Medicine, St. Louis, Missouri; ‡‡Department of Neurosurgery, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina; §§Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ¶¶Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; ‖‖Advocate Children's Hospital, Oak Lawn, Illinois; ##Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ***Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; ‡‡‡Goryeb Children's Hospital of Atlantic Health Systems, Morristown, New Jersey; §§§Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana.

出版信息

Neurosurgery. 2016 Nov;79(5):E627-E629. doi: 10.1227/NEU.0000000000001428.

DOI:10.1227/NEU.0000000000001428

PMID:27759673

Abstract

BACKGROUND

Plagiocephaly, involving positional deformity of the calvarium in infants, is one of the most common reasons for pediatric neurosurgical consultation.

OBJECTIVE

To answer the question: "what is the evidence for the effectiveness of repositioning for positional plagiocephaly?" Treatment recommendations are provided based on the available evidence.

METHODS

The National Library of Medicine MEDLINE database and the Cochrane Library were queried using MeSH headings and key words relevant to repositioning as a means to treat plagiocephaly and brachycephaly. Abstracts were reviewed to identify which studies met the inclusion criteria. An evidentiary table was assembled summarizing the studies and the quality of evidence (Classes I-III). Based on the quality of the literature, a recommendation was rendered (Level I, II, or III).

RESULTS

There were 3 randomized trials (Class I), 1 prospective cohort study (Class II), and 6 retrospective cohort studies (Class III). Repositioning education was found to be equal to a repositioning device and inferior to a physical therapy program. Five of the 7 cohort studies comparing repositioning with a helmet reported helmets to be better and take less time.

CONCLUSION

Within the limits of this systematic review, repositioning education is effective in affording some degree of correction in virtually all infants with positional plagiocephaly or brachycephaly. Most studies suggest that a molding helmet corrects asymmetry more rapidly and to a greater degree than repositioning education. In a Class I study, repositioning education was as effective as repositioning education in conjunction with a repositioning wrap/device. Another Class I study demonstrated that a bedding pillow was superior to physical therapy for some infants. However, in keeping with the American Academy of Pediatrics' warning against the use of soft positioning pillows in the sleeping environment, the Task Force recommends physical therapy over any positioning device. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_3.

摘要

背景

斜头畸形，涉及婴儿颅骨的位置性畸形，是小儿神经外科咨询最常见的原因之一。

目的

回答以下问题：“体位性斜头畸形的复位治疗是否有效？” 根据现有证据提供治疗建议。

方法

使用与复位作为治疗斜头畸形和短头畸形的手段相关的 MeSH 标题和关键词，对美国国立医学图书馆 MEDLINE 数据库和 Cochrane 图书馆进行查询。审查摘要以确定符合纳入标准的研究。编制了一个证据表，总结研究和证据质量（I-III 级）。根据文献质量，提出了建议（I、II 或 III 级）。

结果

有 3 项随机试验（I 级），1 项前瞻性队列研究（II 级）和 6 项回顾性队列研究（III 级）。定位教育与定位装置一样有效，而劣于物理治疗方案。比较定位与头盔的 7 项队列研究中的 5 项报告头盔更好，用时更少。

结论

在本系统评价的范围内，定位教育在几乎所有患有体位性斜头畸形或短头畸形的婴儿中都能有效提供一定程度的矫正。大多数研究表明，塑形头盔比定位教育更能快速且更大程度地纠正不对称。在一项 I 级研究中，定位教育与定位教育结合定位包裹/装置一样有效。另一项 I 级研究表明，对于某些婴儿，床上枕头优于物理治疗。然而，根据美国儿科学会关于在睡眠环境中避免使用柔软定位枕头的警告，专家组建议进行物理治疗，而不是任何定位设备。完整的指南文件可以在 https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_3 找到。