先天性肌性斜颈：利用注视角度和平移畸形评估面部不对称
Congenital muscular torticollis: Use of gaze angle and translational deformity in assessment of facial asymmetry.
作者信息
Bhaskar Atul, Harish U, Desai Hardik
机构信息
Children Orthopaedic Clinic, Mumbai, Maharashtra, India.
Department of Orthopaedics, R N Cooper Hospital, Mumbai, Maharashtra, India.
出版信息
Indian J Orthop. 2017 Mar-Apr;51(2):123-130. doi: 10.4103/ortho.IJOrtho_114_16.
BACKGROUND
Assessment of facial asymmetry is challenging in torticollis deformity. Neck tilt in toroticollis is associated with deviation of horizontal ocular gaze and translation of neck from the midline. These deviations can be assessed clinically and can be used as surrogate marker for facial asymmetry.
MATERIALS AND METHODS
Thirty five children with congenital muscular torticollis (CMT) were classified into three grades of severity based on the new clinical score. The parameters included in the scoring system included rotational deficit, side flexion deficit, gaze angle (GA), and translational deformity (TD). Seven children had Grade I (mild), 18 had Grade II (moderate), and 10 had Grade III (severe) CMT. There were 21 girls and 14 boys with a mean age of 8.46 years (range 3-16 years). Twenty two children underwent a bipolar release, and 13 had unipolar surgery. Facial asymmetry (FA) signs were noted and based on GA and TD; all children had a deviation from the neutral angles (GA of 90° and 0 mm translation from the midsterna plumb line were considered neutral angle). The final outcome was based on the modified Cheng and Tang Score.
RESULTS
The mean GA in Grade I, II, and III improved from 81.71 to 90, 72.77 to 89.16, and 66.60 to 88, respectively (Chi-square < 0.0001). The TD improved from 15 mm to 0 mm, 25.83 mm to 3.05 mm, and 36.6 mm to 6 mm in Grade I, II, and III, respectively (Chi-square < 0.05). The rotational and side flexion deficits also improved across all grades of severity but were not statistically significant ( < 0.911 and < 0.04). Twenty four children had an excellent outcome with complete correction of their GA and TD. Four children with Grade II CMT and seven children with Grade III who had a residual translation of 5 mm or more and GA less than neutral horizontal had a good outcome. No child had problems with scar cosmesis or prominent lateral bands, and there was no recurrence of deformity at a mean followup of 28 months (range 24-32 months).
CONCLUSION
The GA and TD can be used to assess FA in torticollis management and significant improvement can be expected even in severe cases.
背景
斜颈畸形中面部不对称的评估具有挑战性。斜颈中的颈部倾斜与水平眼凝视偏差及颈部从中线平移有关。这些偏差可通过临床评估，且可用作面部不对称的替代指标。
材料与方法
根据新的临床评分，将35例先天性肌性斜颈（CMT）患儿分为三个严重程度等级。评分系统纳入的参数包括旋转缺陷、侧屈缺陷、凝视角度（GA）和平移畸形（TD）。7例患儿为I级（轻度）CMT，18例为II级（中度），10例为III级（重度）。有21名女孩和14名男孩，平均年龄8.46岁（范围3 - 16岁）。22例患儿接受了双极松解术，13例接受了单极手术。记录面部不对称（FA）体征，并基于GA和TD；所有患儿均偏离中立角度（GA为90°且距胸骨中垂线平移0 mm被视为中立角度）。最终结果基于改良的Cheng和Tang评分。
结果
I级、II级和III级的平均GA分别从81.71改善至90、72.77改善至89.16、66.60改善至88（卡方检验<0.0001）。I级、II级和III级的TD分别从15 mm改善至0 mm、25.83 mm改善至3.05 mm、36.6 mm改善至6 mm（卡方检验<0.05）。所有严重程度等级的旋转和侧屈缺陷也有所改善，但无统计学意义（<0.911和<0.04）。24例患儿效果极佳，GA和TD完全矫正。4例II级CMT患儿和7例III级且残留平移5 mm或更多且GA小于中立水平的患儿效果良好。平均随访28个月（范围24 - 32个月）时，无患儿出现瘢痕美观问题或明显的侧带问题，且畸形无复发。
结论
GA和TD可用于斜颈治疗中FA的评估，即使在严重病例中也有望实现显著改善。
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