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Objective:To investigate the effect of using multi-functional torticollis orthosis with manipulation in pediatric congenital myotonic torticollis. Method:In this study,60 children with congenital myotonic torticollis were randomly divided into a test group and a control group.The test group was treated with a multi-torticollis orthosis on the basis of tradition-al corrective manual therapy,while the control group was only treated with manual correction.After three months of treatment,the corrective effect of the orthosis in different neck positions of the children was ob-served.Surface electromyography(sEMG)data analysis was conducted by collecting sEMG signals of the stern-ocleidomastoid muscle in two neck positions:lateral flexion and rotation.The sEMG signal characteristics of each child's sternocleidomastoid muscle were then analyzed.Subsequently,an overall assessment of the treat-ment for the children with torticollis was performed. Result:The root mean square(RMS)values of the sternocleidomastoid surface EMG signals were significantly higher in the test group than those in the control group,with a significant difference(P<0.05).There were sig-nificant differences between the two groups before and after treatment(P<0.01).Overall,the total effective treatment rate in the test group was 96.67%,which was significantly higher than that in the control group,showing a significant difference(P<0.01). Conclusion:In children with early-stage congenital muscular torticollis,the orthosis is precise,reliable,com-fortable and adjustable,and the combination of manual correction makes significant clinical outcomes and im-provements of torticollis in children.
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Abstract Spasmodic torticollis was an early designation used for cervical dystonia. The origin of this name is attributed to French physician and writer François Rabelais in the mid-sixteenth century. This early description of torticollis in the book Pantagruel was an inspiration for the understanding of cervical dystonia. The art expressed in Rabelais' literature - which was immortalized by the drawings of Gustave Doré - influenced poetry, art, and photography, and led to the adoption of the term torticollis in the neurological sciences.
Resumo Uma designação inicial usada para distonia cervical era torcicolo espasmódico. A origem desse termo é atribuída ao médico e escritor francês François Rabelais em meados do século XVI. Essa descrição inicial do torcicolo no livro Pantagruel foi uma inspiração para a compreensão da distonia cervical. A arte exibida na literatura de Rabelais - imortalizada pelos desenhos de Gustave Doré - influenciou a poesia, a arte e a fotografia, e levou à adoção do termo torcicolo nas ciências neurológicas.
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Congenital muscular Torticollis is a rare musculoskeletal disorder characterized by unilateral shortening of the Sternocleidomastoid muscle. Producing deformity of the neck with ?exion of the neck towards the same side and the chin facing the opposite shoulder. We treated six cases, and of which ?ve are due to congenital Sternomastoid shortening (unilateral) and another case with fusion of cervical vertebrae causing Torticollis and Klippel Feil Syndrome with cleft of the soft palate which was also repaired.
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Introducción: Los trastornos congénitos músculo-esqueléticos presentan frecuentemente malformaciones de cadera que afectan la marcha y actividades funcionales, por ello la importancia de detectarlas oportunamente. Objetivo: Determinar la presencia de displasia y luxación de la cadera en niños con alteraciones congénitas que asisten a un instituto nacional de rehabilitación. Material y Métodos: Estudio observacional, descriptivo, retrospectivo y transversal con 150 historias clínicas de niños de 0 a 2 años con alteraciones congénitas con afectación músculo-esquelética. Resultados: Los pacientes presentaron una mediana de edad de 11 meses y 64 % fue del sexo femenino. La alteración más frecuente fue la deformidad congénita de la cadera con 52 %, seguida de la espina bífida, deformidad congénita del ECOM, artrogriposis múltiple y deformidad congénita de los pies con 23,3 por ciento, 6,7 por ciento, 5,3 por ciento y 4 por ciento respectivamente. El 17,3 por ciento de los pacientes con alteraciones congénitas tenía luxación, 56,7 por ciento displasia y 72,7 por ciento alguna de las dos. En los pacientes con deformidad congénita de la cadera, 100 por ciento tenía displasia y/o luxación. En los pacientes con espina bífida, 54,3 por ciento al menos una de ellas. El 75 por ciento de los pacientes con artrogriposis múltiple y 33,3 por ciento de los que tenían deformidades congénitas de los pies presentaron displasia y/o luxación. Conclusiones: La displasia y/o luxación de cadera son frecuentes en niños con diagnóstico de deformidad congénita de cadera, espina bífida, artrogriposis múltiple congénita y deformidades congénitas de los pies(AU)
Introduction: Congenital musculoskeletal disorders often present hip malformations that affect gait and functional activities, therefore the importance of detecting them in a timely manner. Objective: To determine the presence of dysplasia and hip dislocation in children with congenital disorders who attend a national rehabilitation institute. Material and Methods: An observational, descriptive, retrospective and cross-sectional study was conducted using 150 medical records of children from 0 to 2 years of age with congenital disorders with musculoskeletal involvement. Results: The patients had a median age of 11 months and 64 percen were female. The most frequent alteration was congenital deformity of the hip (52 percent), followed by spina bifida, congenital deformity of the ECOM, multiple arthrogryposis, and congenital deformity of the feet (23.3 percen, 6.7 percen, 5.3 percen and 4 percen, respectively). In addition, 17.3 percen of patients with congenital abnormalities had dislocation, 56.7 percen had dysplasia and 72.7 percen had either of the two. In patients with congenital hip deformity, 100% had dysplasia and/or dislocation. In patients with spina bifida, 54.3 percen had at least one of them. Moreover, 75 percen of patients with arthrogryposis multiplex and 33.3 percen of those with congenital deformities of the feet presented dysplasia and/or dislocation. Conclusions: Dysplasia and/or dislocation of the hip are common in children with a diagnosis of congenital hip deformity, spina bifida, congenital arthrogryposis multiplex, and congenital foot deformities(AU)
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Humans , Infant, Newborn , Infant , Child, Preschool , Epidemiology, DescriptiveABSTRACT
Objective:To explore any effect of kinesio taping on the head and neck mobility of children with congenital muscular torticollis.Methods:A total of 52 children with congenital muscular torticollis were randomly divided into a treatment group and a control group, each of 26. All were given 20 minutes of routine rehabilitation training daily, 5 days a week for 4 weeks. The treatment group was additionally taped up with kinesio tape for no more than 48 hours once every 3 days for 4 weeks. Before and after the treatment the angles of head tilt and neck lateral flexion and the gaps in left and right neck rotation were measured for both groups.Results:Significant improvement was observed in both groups but there was significantly more improvement among the treatment group. The treatment had a cure rate (46.15%) and an improvement rate (50.00%) significantly superior to those of the control group and a significantly lower rate of ineffectiveness.Conclusion:Kinesio taping along with routine rehabilitation training can better improve the head and neck mobility of children with congenital muscular torticollis.
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Objective To investigate the EMG characteristics and clinical application value of surface EMG in cervical muscle group of children with congenital muscular torticollis(CMT).Methods A retrospective analysis was performed on 478 children diagnosed as CMT from January 2018 to August 2022 in Rehabilitation Center of the Children's Hospital Affiliated to Chongqing Medical University.The torticollis side of the same case was included in observation group and the healthy side was included in control group.Surface EMG was used to record the electromyography root-mean-square values of bilateral sternocleidomastoid muscles,platysma muscles and upper trapezius muscles in the rest and different exercise states.The difference of root-mean-square values between the affected side and the healthy side muscle groups at rest and under different exercise states and the diagnostic value were compared.Spearman correlation analysis was used to evaluate the relationship between the severity of congenital muscular torticollis on the affected side and the root mean square value of each cervical muscle group.Results The root-mean-square value of sternocleidomastoid muscle on the affected side of CMT children was higher than that on the healthy side during relaxation and lower than that on the healthy side during contraction,and the differences were statistically significant(P<0.05),the abnormal root-mean-square value of the affected side in the resting position and in all motion state has higher diagnostic value.The root-mean-square value of platysma muscle on the affected side was higher than that on the healthy side when it was in the resting position and the reverse neck rotation relaxed state(P<0.05),and lower than that on the healthy side when it was in the same neck rotation contraction state(P<0.05),abnormal values detected in resting sitting position and elevation of head have higher value.Root-mean-square value of upper trapezius muscle on the affected side was higher than that on the healthy side in the relaxed state(P<0.05).The abnormal values in sitting position,turning neck and bending head have high diagnostic value.The severity of CMT was positively correlated with the root-mean-square values of sternocleidomastoid muscle,platysma muscle,and upper trapezius muscle(r was 0.721,0.612,0.655,P<0.001).Conclusion sEMG could be used as a good method for the clinical diagnosis and evaluation of congenital muscular torticollis in children.
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Objective:To evaluate the value of 99Tc m-methoxyisobutylisonitrile(MIBI) SPECT/CT imaging for the identification of dystonic muscles in patients with primary cervical dystonia (PCD). Methods:A total of 10 patients with PCD (3 males, 7 females, age (47.3±9.9) years) and 10 healthy subjects (4 males, 6 females, age (43.5±9.4) years; control group) between August 2019 and October 2021 in China-Japan Friendship Hospital were enrolled prospectively. All subjects underwent 99Tc m-MIBI SPECT/CT scan. The SUV max of 8 bilateral representative muscles, including rectus capitis posterior major, obliquus capitis inferior, splenius capitis, semispinalis, sternocleidomastoid, trapezius, musculus scalenus muscle and levator scapulae were evaluated in control group. In PCD group, muscles with abnormal uptake were determined. ROI was drawn and SUV max was measured. Independent-sample t test was used to analyze the differences of SUV max between normal and abnormal muscles. The detecting rates of neck MRI and SPECT/CT for abnormal muscles were analyzed by χ2 test. Results:Normal muscles of healthy subjects showed mild symmetrical radioactivity distribution, with the SUV max of 1.10±0.19. A total of 60 muscles with abnormal uptake in 10 patients were found, including 7 rectus capitis posterior major, 10 obliquus capitis inferior, 8 splenius capitis, 8 semispinalis, 10 sternocleidomastoid, 5 trapezius, 3 musculus scalenus muscle and 9 levator scapulae. The SUV max of muscles with abnormal uptake was 1.81±0.43, which was higher than that of normal muscles ( t=17.05, P<0.001). Only 30 pieces abnormal hypertrophy muscle were found by neck MRI, and the detecting rate was much lower than that of SPECT/CT (18.75%(30/160) vs 37.50%(60/160); χ2=28.03, P<0.001). Conclusion:99Tc m-MIBI SPECT/CT may be a useful method for identifying dystonic muscles and a guide to precision therapy in patients with PCD.
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Episodic syndromes that may be associated with migraine@#Episodic syndromes that may be associated with migraine are commonly seen in children and are likely to evolve into migraine in the subsequent course of the disease, including several subtypes such as benign paroxysmal torticollis, benign paroxysmal vertigo, and recurrent gastrointestinal disturbance. Understanding the above syndromes has an important clinical significance in the diagnosis of migraine in children.
Subject(s)
Migraine DisordersABSTRACT
@#We report a case of an otherwise healthy 23-month-old boy who presented with nystagmus, head shaking, and abnormal head posture suggestive of spasmus nutans. Neuro-ophthalmologic exam revealed bilateral, low-amplitude, high-frequency, horizontal, disconjugate nystagmus that was more prominent in one eye along with head shaking and a head tilt or face turn. The rest of the exam and the systemic physical examination were normal. Magnetic resonance imaging of the brain did not disclose optic pathway glioma, which has been reported to cause spasmus nutans-like disease. Electroretinogram (ERG) was also recommended to rule out occult retinopathies. However, it was not done due to unavailability of the appropriate corneal electrode for his age. Instead, close follow-up was advised to monitor spontaneous improvement or resolution, or until the child comes of age that he can undergo ERG. This case highlights the management approach and rationale of patients with presumed spasmus nutans. Recognition of the triad of spasmus nutans allows for quick diagnosis and more focused and efficient investigation.
Subject(s)
Nystagmus, Pathologic , Spasms, InfantileABSTRACT
Introducción: La tortícolis muscular congénita es una entidad clínica que se hace evidente al nacimiento o poco después, presenta un amplio espectro de secuelas; algunas de estas, una vez establecidas, pueden requerir complejas y costosas correcciones quirúrgicas. we Objetivo: Caracterizar la tortícolis muscular congénita según elementos clínicos, diagnósticos y terapéuticos. Métodos: Se realizó una búsqueda de literatura relevante sobre el tema en el primer cuatrimestre de 2021. Se utilizaron como buscadores de información científica: Pubmed/Medline, SciELO, Scopus y ScienceDirect, así como fuentes oficiales como, China CDC, CDC y FDA. La estrategia de búsqueda incluyó los siguientes términos como palabras clave: tortícolis muscular congénita, complicaciones dentofaciales y psicológicas, plagiocefalia posicional. Se evaluaron artículos de revisión, de investigación y páginas web que, en general, tenían menos de 10 años de publicados, en idioma español e inglés, y que hicieran referencia específicamente al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 90 referencias bibliográficas, de las cuales 30 se citaron en el presente artículo. Conclusiones: La tortícolis muscular congénita es una enfermedad de observancia frecuente, su diagnóstico clínico y por exámenes complementarios debe hacerse en los primeros meses de vida. La detección y tratamiento rehabilitador precoz constituyen las armas fundamentales para evitar sus secuelas dentofaciales y psicológicas.
Introduction: Congenital muscular torticollis is a clinical entity that becomes evident at birth or shortly thereafter. It presents a wide spectrum of sequelae. Some of these, once established, may require complex and costly surgical corrections. Objective: To characterize congenital muscular torticollis according to clinical, diagnostic and therapeutic elements. Methods: A search for relevant literature on the subject was carried out in the first third of 2021. As information search engines Pubmed/Medline, SciELO, Scopus and ScienceDirect were used; as well as official sources, such as China CDC, CDC and FDA. The search strategy included the following keywords: tortícolis muscular congénita [congenital muscular torticollis], complicaciones dentofaciales y psicológicas [dentofacial and psychological complications], plagiocefalia posicional [positional plagiocephaly]. Review articles, research articles and web pages, in Spanish and in English, were assessed by considering that they had generally been published within less than ten years and that they referred, within their title, specifically to the topic of study. The articles that did not meet these conditions were excluded. This allowed the study of ninety bibliographic references, thirty of which were cited in the present article. Conclusions: Congenital muscular torticollis is a frequently observed disease, which should be diagnosed, clinically and by complementary tests, in the first months of life. Early identification and rehabilitation treatment are the fundamental weapons to avoid its dentofacial and psychological sequelae.
Subject(s)
Humans , Male , Female , Torticollis/diagnosis , Plagiocephaly/diagnosis , Plagiocephaly/therapyABSTRACT
RESUMEN Introducción: Las secuelas de la tortícolis muscular congénita en niños tiene un amplio espectro, algunas de las cuales, una vez establecidas pueden requerir complejas y costosas correcciones quirúrgicas. Objetivo: Caracterizar las secuelas de tortícolis muscular congénita según elementos clínicos, radiológicos y epidemiológicos en niños atendidos en Santiago de Cuba en el periodo 2017-2020. Método: Estudio prospectivo-analítico de caso-control en 112 niños con dicha enfermedad, separados en casos (24 niños) y controles (88 niños). El procesamiento de datos implicó análisis de frecuencias, cálculo de Ji-cuadrado, identificación de factores asociados a variable dependiente, cálculo del valor de p y Odds ratio. Resultados: Se obtuvo predominio de población masculina en casos (70,8 %) y controles (68,2 %), con asociación estadística entre edad ≥ 6 meses al momento del diagnóstico y presencia de complicaciones (OR: 2,4-20,4; p=0,00). Existió asociación estadística entre macrosomía al nacer y presencia de complicaciones en 25,0 % de casos y 11,4 % de controles (OR: 1,9-12,5; p=0,02). Hubo asociación estadística entre inicio tardío del tratamiento rehabilitador y complicaciones (OR: 2,86-21,3; p=0,00). Conclusiones: Se observó predominio de complicaciones orgánicas o comorbilidades en varones, siendo más probable el incremento significativo de secuelas en estos y cuando se inicia el tratamiento médico después de los 6 meses de edad. Las complicaciones más frecuentes fueron: asimetría facial, plagiocefalia y asociación de dos o más secuelas.
ABSTRACT Introduction: Sequelae of congenital muscular torticollis in children have a wide spectrum, some of which, set already, may require complex and costly surgical corrections. Objective: To characterize the sequelae of congenital muscular torticollis according to clinical, radiological, and epidemiological elements in children attended in Santiago de Cuba from 2017 to 2020. Method: Prospective-analytical case-control study in 112 children with this disease, separated in cases (24 children) and controls (88 children). Data processing involved frequency analysis, calculation of chi-square, identification of factors associated with dependent variable, calculation of the p-value and OR. Results: The male population predominated in cases (70.8%) and controls (68.2%), with a statistical association between age ≥ 6 months at diagnosis and the presence of complications (OR: 2.4-20.4; p=0.00). There was a statistical association between macrosomia at birth and the presence of complications in 25.0 % of cases and 11.4 % of controls (OR: 1.9-12.5; p=0.02). There was a statistical association between late initiation of rehabilitation treatment and complications (OR: 2.86-21.3; p=0.00). Conclusions: A predominance of organic complications or comorbidities was observed in males, with a significant increase of sequelae in this group and also when medical treatment is started after 6 months of age. The most frequent complications were facial asymmetry, plagiocephaly and association of two or more sequelae.
RESUMO Introdução: As sequelas do torcicolo muscular congênito em crianças têm amplo espectro, algumas das quais, uma vez estabelecidas, podem exigir correções cirúrgicas complexas e onerosas. Objetivo: Caracterizar as sequelas do torcicolo muscular congênito segundo elementos clínicos, radiológicos e epidemiológicos em crianças atendidas em Santiago de Cuba no período 2017-2020. Método: Estudo prospectivo-analítico caso-controle em 112 crianças com essa doença, separadas em casos (24 crianças) e controles (88 crianças). O processamento dos dados envolveu análise de frequência, cálculo do Qui-quadrado, identificação dos fatores associados à variável dependente, cálculo do valor de p e Odss ratio. Resultados: Obteve-se predominância da população masculina nos casos (70,8%) e controles (68,2%), com associação estatística entre idade ≥ 6 meses no momento do diagnóstico e presença de complicações (OR: 2,4-20,4; p=0,00). Houve associação estatística entre macrossomia ao nascimento e presença de complicações em 25,0% dos casos e 11,4% dos controles (OR: 1,9-12,5; p=0,02). Houve associação estatística entre início tardio do tratamento de reabilitação e complicações (OR: 2,86-21,3; p=0,00). Conclusões: Observou-se predominância de complicações orgânicas ou comorbidades no sexo masculino, com aumento significativo de sequelas sendo mais provável nestes e quando o tratamento médico é iniciado após os 6 meses de idade. As complicações mais frequentes foram: assimetria facial, plagiocefalia e associação de duas ou mais sequelas.
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Resumen Introducción: La Fibromatosis Colli es un tumor fibroso congénito benigno que se desarrolla en el músculo esternocleidomastoideo. Se manifiesta clínicamente por hinchazón del cuello y restricción de movimiento del cuello (tortícolis). Objetivo: Describir los aspectos diagnósticos y terapéuticos fundamentales de la Fibromatosis de Colli o Tortícolis Muscular Congénita. Caso Clínico: Se presenta un caso de neonato de sexo femenino de 21 días de nacida mediante parto en presentación podálica. Al examen físico se encuentra masa en cuello de 1,5*2 cm indolora e inclinación de la cabeza hacia la derecha, diagnosticado con ultrasonografía y tomografía de cuello contrastado, sin otros hallazgos. Conclusiones: La Fibromatosis de Colli es una patología que pasa desapercibida en el examen posparto del recién nacido. Es importante que el personal médico la identifique, evitando así complicaciones futuras, como asimetría craneofacial, escoliosis cervical y torácica o alteraciones oculares importantes.
Abstract Introduction: Fibromatosis Colli is a benign congenital fibrous tumor, which develops in the sternocleidomastoid muscle. Its clinical manifestations encompass neck swelling and torticollis (restriction of neck movements). Objective: The aim of this report is to describe the fundamental diagnostic and therapeutic aspects of Fibromatosis Colli or Congenital Muscular Torticollis. Clinical Case: A case of a 21-day-old female neonate is presented, with the presence of a right cervical mass (1.5*2 cm) and the head tilted to the right without other associated symptoms found in the physical examination. A relevant antecedent is breech presentation during the birth. The diagnosis is obtained through ultrasonography and contrasted neck tomography. Conclusions: Fibromatosis Colli is a pathology that could be unnoticed in the postpartum examination of the newborn. It is important that medical personnel identify it in order to avoid future complications, such as craniofacial asymmetry, cervical and thoracic scoliosis, or important ocular alterations.
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Hanger reflex is a common phenomenon in the population that involuntary head and neck rotation or skew occurs when applying pressure to the forehead, tempus or occipitalia with an ordinary wire hanger tightly around the head. The hanger reflex is consistent with the characteristics of sensory tricks in dystonia, and the phenomenon induced by it in normal people should be regarded as negative sensory tricks in dystonia. The mechanism of dystonia behind the hanger reflex and its therapeutic potential deserve more clinicians′ attention.
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Professor WU Lian-zhong's experience in treating spasmodic torticollis by Kaiqiao Shunjin method (resuscitation and regulating muscle) is summarized in this paper. The pathogenesis of spasmodic torticollis is the occluded brain orifices and delirium, qi disorder of meridian tendons, specifically divided into five categories: damp-heat, liver-yang hyperactivity, liver-kidney yin deficiency, deficiency of the governor vessel, excess of the governor vessel. The treatment should be based on the symptoms and the root causes, the symptoms should be the main treatment, and the root cause should be treated based on syndrome differentiation. The main treatment is Kaiqiao Shunjin method (resuscitation and regulating muscle), and to take the chief (five heart acupoints-Shuigou [GV 26], Laogong [PC 8], Yongquan [KI 1]), deputy (Yintang [GV 24+], Shangxing [GV 23] through Baihui [GV 20], Ximen [PC 4]), assistant (Fenglong [ST 40], Lianquan [CV 23], combined with tongue needle prick), envoy (Hanyan [GB 4]) as the basic main acupoints, at the same time cooperate with local acupoints to remove knots and accumulation. Finally, syndrome differentiation is adopted to dredge meridians and disperse knots, regulate the governor vessel, and nourish yin and dispel wind.
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy/history , Meridians , Needles , Syndrome , Torticollis/therapyABSTRACT
La tortícolis es una contractura involuntaria unilateral del esternocleidomastoideo y de la musculatura posterior del cuello que causa la inclinación de la cabeza hacia un lado. Se han descrito múltiples causas de torticolis siendo una de ellas la subluxación atloaxoidea atraumática asociada a un proceso de carácter inflamatorio en la región de cabeza y cuello, llamada síndrome de Grisel. Aunque la mayoría de los pacientes suelen recuperarse sin secuelas tras tratamiento médico existe la posibilidad de complicaciones graves con déficits funcionales, de ahí la importancia de la realización de un diagnóstico y tratamiento precoz.
Torticollis is an unilateral involuntary contracture of the sternocleidomastoid and posterior neck musculature that causes the head tilts to the one side. Multiple causes of torticolis have been described, one of them being the non-traumatic rotatory subluxation of the atlantoaxial joint associated with an inflammatory process in the head and neck region, called Grisel's syndrome. Although most patients usually recover without sequels after medical treatment, there is the possibility of serious complications with functional deficits, that is why the importance of an early diagnosis and treatment of this potology.
Subject(s)
Humans , Torticollis , Atlanto-Axial Joint , Cervical Atlas , Axis, Cervical VertebraABSTRACT
ABSTRACT Objective: The treatment of C1-C2 rotatory dislocation remains controversial and surgery is rare. Surgical treatment is indicated when the injury satisfies the instability criteria or when it cannot be reduced. The objective of this study is to analyze the principles and the adaptations necessary for treating these injuries in the pediatric population. Methods: A retrospective case series study. Three cases of patients diagnosed with traumatic C1-C2 rotatory dislocation and treated surgically in our hospital were studied. Through critical analysis of the available literature, a practical guide was proposed to establish the principles and competencies for the treatment of these injuries. Results: The operated cases were female patients between 8 and 16 years of age, with a diagnosis of traumatic atlantoaxial dislocation. Two patients required preoperative skeletal traction with halo. All patients underwent posterior instrumented arthrodesis, two with a transarticular screw technique and one with mass and C2 isthmic (Göel-Harms) screws. Conclusion:. It is essential to determine if the injury is stable and reducible. We recommend treating this type of injury keeping the criteria and competencies related to the stability, alignment, biology and function of the spine in mind. Level of evidence IV; Case series.
RESUMO Objetivo: O tratamento da luxação rotacional de C1-C2 permanece controverso, e a cirurgia é rara. O tratamento cirúrgico é indicado quando a lesão satisfaz os critérios de instabilidade ou quando não pode ser reduzida. O objetivo deste estudo é analisar os princípios e a adequação necessários para tratar essas lesões na população pediátrica. Métodos: Estudo retrospectivo de série de casos. Foram estudados três casos em pacientes tratados cirurgicamente em nosso hospital com diagnóstico de luxação rotacional traumática de C1-C2. Por meio de análise crítica da literatura disponível, foi proposto um guia prático para estabelecer os princípios e a adequação do tratamento dessas lesões. Resultados: Os casos submetidos à cirurgia foram pacientes do sexo feminino, entre 8 e 16 anos de idade, com diagnóstico de luxação atlantoaxial traumática. Duas pacientes precisaram de tração esquelética pré-operatória com halo. Todas as pacientes foram submetidas à artrodese instrumentada por via posterior, duas com técnica de parafuso transarticular e uma com parafusos de massa e pedículo e lâmina em C2 (técnica de Göel-Harms). Conclusões: É essencial determinar se a lesão é estável e se pode ser reduzida. Recomenda-se tratar esse tipo de lesão tendo em mente os critérios e a adequação relacionados com estabilidade, alinhamento, biologia e função da coluna vertebral. Nível de evidência IV; Série de casos.
RESUMEN Objetivo: El tratamiento de la luxación rotatoria de C1-C2 permanece controversial y la cirugía es rara. Se indica tratamiento quirúrgico cuándo la lesión cumple criterios de inestabilidad o cuándo es considerada irreductible. El objetivo de este estudio es revisar los principios y competencias necesarios para tratar esas lesiones en la población pediátrica. Métodos: Estudio retrospectivo de serie de casos. Se estudian tres casos en pacientes tratados quirúrgicamente en nuestro hospital con diagnóstico de luxación rotatoria de C1-C2 traumática. A través del análisis crítico de la literatura disponible se elabora un esquema práctico para establecer los principios y competencias para el abordaje de estas lesiones. Resultados: Los casos intervenidos fueron pacientes de sexo femenino entre 8 y 16 años, con diagnóstico de luxación atlantoaxoidea traumática. Dos pacientes requirieron tracción esquelética preoperatoria con halo. A todas las pacientes se les practicó artrodesis instrumentada por vía posterior, dos con técnica de tornillos transarticulares y una con tornillos de masa e ístmicos de C2 (Göel-Harms). Conclusiones: Resulta imprescindible determinar si la lesión es estable y reductible. Siempre abordar este tipo de lesiones teniendo presentes los criterios y competencias relacionados con la estabilidad, alineación, biología y función de la columna vertebral. Nivel de Evidencia IV; Serie de casos.
Subject(s)
Humans , Joint Dislocations , Cervical Atlas , Axis, Cervical Vertebra , TorticollisABSTRACT
The thinking and experience of professor
Subject(s)
Humans , Acupuncture Points , Acupuncture Therapy , Meridians , Moxibustion , Torticollis/therapyABSTRACT
Objective:To explore the clinical characteristics and short-term prognosis of reoperation of congenital muscular torticollis (CMT).Methods:A total of 12 cases of recurrent CMT treated in the First Affiliated Hospital of Zhengzhou University from May 2015 to May 2018 were recruited, involving 9 boys and 3 girls with the mean age of 13.2 (8-16) years.The causes of disease recurrence were analyzed, and the postoperative appearance of the children was observed by follow-up.In addition, the prognosis of CMT was evaluated by patient satisfaction survey and Lee score criteria.Results:Among the 12 patients, 10 cases were treated in other hospitals and 2 cases in this hospital.The age of the first surgery ranged from 6 months to 2.2 years.Surgical methods included minimally invasive small needle knife (2 cases), single head release of small incision (5 cases), simple amputation (7 cases) and broken end silk thread ligation (4 cases). During the second surgery, contracture and adhesion of sternocleidomastoid muscle at varying degrees were confirmed, including contracture and adhesion of platysma muscle (3 cases), difficulty in separation of jugular sheath (8 cases), and repair of rupture of internal jugular vein (2 cases). Bipolar release of sternocleidomastoid muscle was performed in all surgeries, and tension-free alignment of the neck to the midline was the complete basis for release.The postoperative appearance of all children was satisfied.They were followed up for an average of 2.3 (1.2-3.0) years.Nine and 3 cases graded more than 90 and 80 patient satisfaction scores, respectively.Lee scores reflected the range of motion of head and neck, and the distance and degree of head deviation from the midline, which yielded excellent, good and fair in 12 cases, 8 cases and 3 cases, respectively.Conclusions:Incomplete release is believed as the basic cause of recurrence in children with CMT.Meanwhile, muscle scar adhesion, early operative age, minimally invasive incision and lack of postoperative rehabilitation may also be the direct factors for CMT recurrence.For recurrent patients, satisfactory therapeutic effect can be achieved through bipolar release, especially complete release of the lower pole, combined with postoperative neck traction, fixation and rehabilitation exercise.
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Objective:To explore the value of congenital muscular torticollis severity classification scores (CMT-SCSTs) in the diagnosis and prognosis of infants′ congenital muscular torticollis (CMT).Methods:A total of 89 CMT children were examined using ultrasound to determine the size of the affected side and the contralateral sternocleidomastoid mass or the abnormal area of the muscle fringe echo from the head and neck. They were also rated using CMT-SCST scoring. They were then given 15 minutes of massage once a day and 5 minutes postural correction twice a day for 3 to 6 months. They were reviewed using ultrasound and the CMT-SCST 3 and 6 months later.Results:The number of treatments was negatively correlated with the initial CMT-SCST score. For those with a baseline CMT-SCST score ≥7 it was effective after 3 and 6 months. Those with a baseline CMT-SCST score ≥9 were almost cured after 3 and 6 months. Gender, age, signs of hip dysplasia, and comorbid global developmental delay (GDD) were not consistently related to the severity and the outcome of CMT. The CMT-SCST was more sensitive in prognosis than the CMT-SCS published in 2013.Conclusions:CMT-SCST scoring provides a theoretical foundation for the diagnosis and treatment and evaluation of infants with CMT. It deserves wider popularity and application in clinical practice.
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Objective:To discuss the clinical results of treatment for congenital muscular torticollis with different injection points of botulinum toxin type A and traditional conservative method, and to expound the safety and effectiveness of this way.Methods:From January 2018 to December 2018, 60 cases aged from one month to six months with congenital muscular torticollis who visited the outpatient clinic of plastic surgery in Children's Hospital of Quanzhou, a teaching hospital of FuJian Medical University, and there were 38 males and 22 females. The treatment groups were divided into two groups according to random number method that were treated with botulinum toxin type A: the single point group was given one point injection, and the three-point group was injected with three points, while the control group was treated with traditional conservative treatment (mainly manual stretching exercises). The number of cases in each group was 20.Results:The differences of muscle thickness and muscle length were repeatedly measured at different time points in the same group and variance analysis conducted. The results showed that there were statistical significances among the two indicators at different time points in each group ( P<0.05). Least significant difference (LSD) was further adopted for pairwise comparison between indicators at different time points in each group and the differences were statistically significant ( P<0.05). In the comparison of treatment effect of different groups after twelve months follow-up, the cure rate was 85% (17 cases) in the single point group, 95 % (19 cases) in the three-point group, and 80 % (16 cases) in the control group, there was no significant difference among three groups ( P>0.05). Conclusions:Local injection of botulinum toxin type A is a safe and effective treatment option for congenital muscular torticollis, which can achieve the same clinical effect as traditional conservative treatment.