位置性颅骨畸形。
Positional Skull Deformities.
出版信息
Dtsch Arztebl Int. 2017 Aug 7;114(31-32):535-542. doi: 10.3238/arztebl.2017.0535.
BACKGROUND
Especially in the first 6 months of life, skull deformities manifesting as a uni- or bilateral flattening of the occiput often give rise to questions of differential diagnosis and potential treatment. In this review, the authors summarize the current understanding of risk factors for this condition, and the current state of the relevant diagnostic assessment and options for treatment.
METHODS
The recommendations given in this selective review of the literature are based on current studies and on existing guidelines on the prevention of sudden infant death, the recommendations of the German Society for Pediatric Neurology (Deutsche Gesellschaft für Neuropädiatrie), and the American guidelines on the treatment of positional plagiocephaly in infancy.
RESULTS
Pre-, peri-, and postnatal risk factors can contribute to the development of positional skull deformities. These deformities can be diagnosed and classified on the basis of their clinical features, supplemented in unclear cases by ultrasonography of the cranial sutures. The putative relationship between positional skull deformities and developmental delay is currently debated. The main preventive and therapeutic measure is parent education to foster correct positioning habits (turning of the infant to the less favored side; prone positioning on occasion when awake) and beneficial stimulation of the infant (to promote lying on the less favored side). If the range of motion of the head is limited, physiotherapy is an effective additional measure. In severe or refractory cases, a skull orthosis (splint) may be useful.
CONCLUSION
The parents of children with positional skull deformities should be comprehensively informed about the necessary preventive and therapeutic measures. Treatment should be initiated early and provided in graded fashion, according to the degree of severity of the problem. Parental concern about the deformity should not be allowed to lead to a rejection of the reasonable recommendation for a supine sleeping position.
背景
尤其是在生命的头 6 个月，以单侧或双侧枕骨扁平为表现的颅骨畸形常引起鉴别诊断和潜在治疗的问题。在这篇综述中，作者总结了这种情况的当前危险因素，以及当前相关诊断评估和治疗选择的现状。
方法
本文献选择性综述中给出的建议基于当前研究以及关于预防婴儿猝死的现有指南、德国儿科神经病学会（Deutsche Gesellschaft für Neuropädiatrie）的建议以及关于婴儿体位性斜头畸形治疗的美国指南。
结果
产前、围产期和产后的危险因素都可能导致体位性颅骨畸形的发展。这些畸形可以根据其临床特征进行诊断和分类，在不明确的情况下，可通过颅骨缝的超声检查进行补充。体位性颅骨畸形与发育迟缓之间的假定关系目前存在争议。主要的预防和治疗措施是对家长进行教育，以促进正确的体位习惯（将婴儿转向不太受青睐的一侧；偶尔在清醒时让婴儿趴着）和婴儿的有益刺激（促进婴儿躺在不太受青睐的一侧）。如果头部活动范围受限，物理治疗是一种有效的附加措施。在严重或难治性病例中，颅骨矫形器（夹板）可能有用。
结论
应全面告知患有体位性颅骨畸形的儿童的父母所需的预防和治疗措施。应根据问题的严重程度尽早开始并分级提供治疗。不应因父母对畸形的担忧而拒绝合理的仰卧睡眠建议。
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