神经外科医师协会关于体位性斜头畸形患者管理的系统评价和循证指南：重新定位的作用
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on the Management of Patients With Positional Plagiocephaly: The Role of Repositioning.
作者信息
Klimo Paul, Lingo Patrick Ryan, Baird Lissa C, Bauer David F, Beier Alexandra, Durham Susan, Lin Alexander Y, McClung-Smith Catherine, Mitchell Laura, Nikas Dimitrios, Tamber Mandeep S, Tyagi Rachana, Mazzola Catherine, Flannery Ann Marie
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.
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.
背景
扁头畸形，涉及婴儿颅骨的位置性畸形，是小儿神经外科会诊最常见的原因之一。
目的
回答问题：“重新定位治疗位置性扁头畸形的有效性证据是什么？” 根据现有证据提供治疗建议。
方法
使用与重新定位相关的医学主题词和关键词查询美国国立医学图书馆的MEDLINE数据库和Cochrane图书馆，以此作为治疗扁头畸形和短头畸形的一种手段。对摘要进行审查以确定哪些研究符合纳入标准。汇编了一个证据表，总结了这些研究以及证据质量（I - III级）。根据文献质量给出了建议（I级、II级或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）。发现重新定位教育与重新定位装置效果相当，但不如物理治疗方案。在7项比较重新定位与头盔的队列研究中，有5项报告头盔效果更好且所需时间更短。
结论
在本系统评价的范围内，重新定位教育对于几乎所有患有位置性扁头畸形或短头畸形的婴儿在一定程度上进行矫正有效。大多数研究表明，塑形头盔比重新定位教育能更快速、更显著地矫正不对称。在一项I级研究中，重新定位教育与结合重新定位包裹物/装置的重新定位教育效果相同。另一项I级研究表明，对于一些婴儿，床垫枕头优于物理治疗。然而，鉴于美国儿科学会对在睡眠环境中使用柔软定位枕头的警告，特别工作组建议采用物理治疗而非任何定位装置。完整的指南文件可在https://www.cns.org/guidelines/guidelines - management - patients - positional - plagiocephaly/Chapter_3获取。
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