Cheng J C, Au A W
Department of Orthopaedics and Traumatology, Faculty of Medicine, Chinese University of Hong Kong.
J Pediatr Orthop. 1994 Nov-Dec;14(6):802-8.
We reviewed 624 cases of infantile torticollis in one centre over a period of 7 years. The incidence of torticollis was found to be 1.3% in Chinese children. Boy-to-girl ratio was 3:2. Obstetric histories of the mothers showed a total of 62.2% with difficult labour, breech deliveries, or caesarean section, and 6.04% had associated congenital anomalies. Of all the cases, 27.88% were found to be postural, 35.4% had torticollis that presented with sternomastoid tumor, and 36.7% presented with muscular torticollis alone. When limitation of neck range was considered, 36.7% had a passive rotation deficit > 15 degrees. In patients presenting in the early stages, 97% of all infantile torticollis cases resolved with conservative treatment, active stimulation, and a passive stretching program. For those responding to treatment, the mean treatment period was < 6 months for varying degrees of neck rotational deficit. Patients with cord-like muscular torticollis and a rotational > 30 degrees were more likely to need surgery. Presence of sternomastoid tumor alone was not found to increase the likelihood of surgery. Musculoskeletal sequelae after torticollis had resolved included intermittent head tilt and persistence of mild craniofacial asymmetry. We recommend continuous follow-up in cases of infantile torticollis, particularly in patients with progression of sternomastoid tumor to muscular torticollis.
我们回顾了一个中心7年间624例小儿斜颈病例。发现中国儿童斜颈发病率为1.3%。男女比例为3:2。母亲的产科病史显示，62.2%有难产、臀位分娩或剖宫产史，6.04%伴有先天性异常。在所有病例中，27.88%为姿势性斜颈，35.4%的斜颈伴有胸锁乳突肌肿块，36.7%仅表现为肌肉性斜颈。当考虑颈部活动范围受限时，36.7%的患者被动旋转受限>15度。在早期就诊的患者中，97%的小儿斜颈病例通过保守治疗、主动刺激和被动伸展方案得以治愈。对于治疗有反应的患者，不同程度的颈部旋转受限的平均治疗期<6个月。伴有条索状肌肉性斜颈且旋转>30度的患者更有可能需要手术。单独存在胸锁乳突肌肿块并未增加手术的可能性。斜颈治愈后的肌肉骨骼后遗症包括间歇性头部倾斜和轻度颅面不对称持续存在。我们建议对小儿斜颈病例进行持续随访，特别是对于胸锁乳突肌肿块进展为肌肉性斜颈的患者。
