Limpaphayom Noppachart, Kohan Eitan, Huser Aaron, Michalska-Flynn Malgorzata, Stewart Sara, Dobbs Matthew B
Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Orthopaedic Surgery, Washington University in St. Louis.
J Pediatr Orthop. 2019 May/Jun;39(5):e343-e348. doi: 10.1097/BPO.0000000000001302.
Physical therapy (PT) alone is not always effective for treatment of congenital muscular torticollis (CMT). The adjunctive use of botulinum toxin (BTX) injection into the sternocleidomastoid, followed by PT, could provide correction and avoid more invasive surgery. Aims of the study were to review clinical and caregiver-reported outcomes of children with resistant CMT treated by BTX injection combined with a guided-PT program.
Medical records of consecutive children with resistant CMT treated by our protocol between 2010 and 2015 were reviewed. A minimum 2-year follow-up was required. Demographic parameters, numbers of BTX required and pre-BTX and post-BTX head tilt and range of neck rotation were recorded. A univariate analysis test was conducted to identify variables related to the need of repeated BTX injections. A phone interview with the caregivers was done regarding their satisfaction.
A cohort of 39 patients with treatment resistant CMT were identified that had an average age of 14 (range, 6.5 to 27.6) months at initiation of BTX treatment. Multiple BTX injections were utilized in 21/39 (54%) of patients. No patient required tendon lengthening surgery. At the final evaluation, there was improvement in both head tilt (18.7±6.8 degrees vs. 1.7±2.4 degrees, mean difference (95% CI) 16.9 (14.6-19.3); P<0.001) and range of neck motion (56.0°±11.7 degrees vs. 86.0±3.8 degrees, mean difference (95% CI) 30.0 (26.1-33.9), P<0.001). Pre-BTX parameters were not associated with the requirement of repeated BTX injections (P>0.05). Caregivers were satisfied with the treatment protocol. No untoward effect was observed during the study period.
The proposed minimally invasive protocol provided correction of resistant CMT and obviated the need for more invasive surgical procedures.
Level IV.
单纯物理治疗（PT）对先天性肌性斜颈（CMT）的治疗并不总是有效。在胸锁乳突肌注射肉毒杆菌毒素（BTX）并联合PT治疗，可能会起到矫正作用并避免更具侵入性的手术。本研究的目的是回顾经BTX注射联合引导式PT方案治疗的难治性CMT患儿的临床及照顾者报告的结局。
回顾2010年至2015年间按照我们的方案治疗的连续性难治性CMT患儿的病历。要求至少随访2年。记录人口统计学参数、所需BTX的次数以及BTX注射前后的头部倾斜度和颈部旋转范围。进行单因素分析测试以确定与重复BTX注射需求相关的变量。对照顾者进行电话访谈以了解他们的满意度。
确定了一组39例难治性CMT患者，BTX治疗开始时的平均年龄为14（范围6.5至27.6）个月。21/39（54%）的患者接受了多次BTX注射。没有患者需要进行肌腱延长手术。在最终评估时，头部倾斜度（18.7±6.8度对1.7±2.4度，平均差值（95%CI）16.9（14.6 - 19.3）；P<0.001）和颈部活动范围（56.0°±11.7度对86.0±3.8度，平均差值（95%CI）30.0（26.1 - 33.9），P<0.001）均有改善。BTX注射前的参数与重复BTX注射的需求无关（P>0.05）。照顾者对治疗方案满意。在研究期间未观察到不良影响。
所提出的微创方案矫正了难治性CMT，避免了更具侵入性的手术程序的需要。
IV级。
