*Department of Pediatric Neurological Surgery, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania; ‡Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; §Advocate Children's Hospital, Oak Lawn, Illinois; ¶Division of Pediatric Neurosurgery, University of Florida Health Jacksonville, Jacksonville, Florida; ‖Department of Neurological Surgery, Oregon Health and Science University, Portland, Oregon; #Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; **Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont; ‡‡Semmes-Murphey Neurologic & Spine Institute; Department of Neurosurgery, University of Tennessee Health Science Center; Le Bonheur Children's Hospital, Memphis, Tennessee; §§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; ¶¶Goryeb Children's Hospital of Atlantic Health Systems, Morristown, New Jersey; ‖‖Department of Neurosurgery, Palmetto Health University of South Carolina Medical Group, Columbia, South Carolina; ##Guidelines Department, Congress of Neurological Surgeons, Schaumburg, Illinois; ***Department of Surgery, Division of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; ‡‡‡Kids Specialty Center, Women's & Children's Hospital, Lafayette, Louisiana.
Neurosurgery. 2016 Nov;79(5):E632-E633. doi: 10.1227/NEU.0000000000001430.
No evidence-based guidelines exist on the role of cranial-molding orthosis (helmet) therapy for patients with positional plagiocephaly.
To address the clinical question: "Does helmet therapy provide effective treatment for positional plagiocephaly?" and to make treatment recommendations based on the available evidence.
The US National Library of Medicine Medline database and the Cochrane Library were queried by using MeSH headings and key words relevant to the objective of this systematic review. Abstracts were reviewed, after which studies meeting the inclusion criteria were selected and graded according to their quality of evidence (Classes I-III). Evidentiary tables were constructed that summarized pertinent study results, and, based on the quality of the literature, recommendations were made (Levels I-III).
Fifteen articles met criteria for inclusion into the evidence tables. There was 1 prospective randomized controlled trial (Class II), 5 prospective comparative studies (Class II), and 9 retrospective comparative studies (Class II).
There is a fairly substantive body of nonrandomized evidence that demonstrates more significant and faster improvement of cranial shape in infants with positional plagiocephaly treated with a helmet in comparison with conservative therapy, especially if the deformity is severe, provided that helmet therapy is applied during the appropriate period of infancy. Specific criteria regarding the measurement and quantification of deformity and the most appropriate time window in infancy for treatment of positional plagiocephaly with a helmet remains elusive. In general, infants with a more severe presenting deformity and infants who are helmeted early in infancy tend to have more significant correction (and even normalization) of head shape. The full guidelines document can be located at https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_5.
目前尚无循证医学指南可用于指导颅面矫形头盔（头盔）治疗位置性斜头畸形。
解决临床问题：“头盔治疗是否对头位性斜头畸形有效？”并根据现有证据提出治疗建议。
美国国立医学图书馆的 Medline 数据库和 Cochrane 图书馆使用与本系统评价目的相关的 MeSH 标题和关键词进行查询。审查摘要后，选择符合纳入标准的研究，并根据其证据质量进行分级（I-III 级）。构建证据表以总结相关研究结果，并根据文献质量提出建议（I-III 级）。
有 15 篇文章符合纳入证据表的标准。其中有 1 项前瞻性随机对照试验（II 级），5 项前瞻性对照研究（II 级）和 9 项回顾性对照研究（II 级）。
有大量非随机证据表明，与保守治疗相比，头盔治疗可更显著和更快地改善位置性斜头畸形婴儿的头型，尤其是在畸形严重的情况下，如果在婴儿期的适当时期应用头盔治疗。关于畸形的测量和量化以及婴儿期治疗位置性斜头畸形的最合适时间窗口的具体标准仍难以确定。一般来说，头型畸形严重的婴儿和婴儿期早期戴头盔的婴儿，头型矫正（甚至正常化）的幅度更大。完整的指南文件可在 https://www.cns.org/guidelines/guidelines-management-patients-positional-plagiocephaly/Chapter_5 找到。
Zotero 插件