Li Haichong,Li Hao,Guo Dong,et al.Arthroscopically assisted radiofrequency tenotomy for congenital muscular torticollis in children[J].Journal of Clinical Pediatric Surgery,2024,(07):648-652.[doi:10.3760/cma.j.cn101785-202212036-008]
关节镜下双极电极松解治疗儿童先天性肌性斜颈的优势及应用价值
- Title:
- Arthroscopically assisted radiofrequency tenotomy for congenital muscular torticollis in children
- Keywords:
- Congenital Muscular Torticollis; Arthroscopy; Radiofrequency; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨关节镜下双极电极松解治疗儿童先天性肌性斜颈(congenital muscular torticollis,CMT)的优势及应用价值。方法 回顾性分析2019年6月至2022年6月首都医科大学附属北京儿童医院骨科收治的CMT患儿资料。根据美国儿童肌性斜颈临床实践指南,术前对入组患儿进行严重程度分级。根据手术方式的不同,将患儿分为关节镜下双极电极松解组及开放手术组。分别于术后1周、1个月、3个月以及1年进行门诊复查,并利用Cheng评分进行临床疗效判定。结果 本研究共纳入CMT患儿83例,严重程度分级:8级82例、7级1例。关节镜下双极电极松解组共46例,开放手术组共37例,两组患儿性别比例、手术年龄、病史时间、术前严重程度分级比较,差异均无统计学意义(P>0.05)。关节镜下双极电极松解组的手术时间长于开放手术组;关节镜下双极电极松解组的切口长度及术后住院时间均短于开放手术组,差异均有统计学意义(P<0.05)。两组术后随访(1.8±1.0)年,Cheng评分等级:优秀80例,良好3例。两组术后各有2例出现皮下积液,并发症发生率及 Cheng评分差异均无统计学意义(P>0.05)。结论 关节镜下双极电极松解治疗儿童CMT虽较传统切开手术延长了手术时间,但术中视野清晰,伤口隐蔽,手术损伤小,患儿恢复快,手术疗效满意。
- Abstract:
- Objective To discuss the advantage of arthroscopically assisted radiofrequency tenotomy of sternocleidomastoid muscle for congenital muscular torticollis (CMT) in children.Methods From June 2019 to June 2022,the relevant clinical data were retrospectively reviewed for 83 CMT children.According to the 2018 American Physical Therapy Association’s clinical practice guidelines of children with muscular torticollis,disease severity was graded pre-operation.Based upon specific operations,they were assigned into two groups of arthroscopiclly assisted radiofrequency tenotomy (n=46) and open operation (n=37).Outpatient re-examinations were performed at Week 1 and Month 1/3 post-operation.Postoperative follow-ups were conducted with Cheng’s scoring system.Results Clinical grades were Ⅷ (n=82) and Ⅶ (n=1).No significant inter-group differences existed in gender ratio,operative age,medical history or preoperative severity.Operative duration of radiofrequency tenotomy group was longer than that of open operation group .Incision length and postoperative hospitalization stay were significantly shorter in radiofrequency tenotomy group than those in open operation group and (3.3±1.1) vs.(3.6±1.6) day,P<0.001].During an average follow-up period of (1.8±1.0) years,Cheng’s score was excellent (n=80) and decent (n=3).Two cases of subcutaneous effusion occurred in each group.No inter-group difference existed in complication rate or Cheng’s score.Conclusions Operative duration of radiofrequency tenotomy of CMT is longer than that of open operation.Arthroscopically assisted radiofrequency therapy for CMT offers the advantages of safety,mini-invasiveness and satisfactory efficacy.
参考文献/References:
[1] 邱鑫,熊竹,曾帅丹,等.腔镜治疗儿童先天性肌性斜颈的系统评价和Meta分析[J].中华小儿外科杂志,2021,42(5):392-402.DOI:10.3760/cma.j.cn421158-20200215-00071. Qiu X,Xiong Z,Zeng SD,et al.Endoscopy for congenital muscular torticollis in children:a systematic review and Meta-analysis[J].Chin J Pediatr Surg,2021,42(5):392-402.DOI:10.3760/cma.j.cn421158-20200215-00071.
[2] Jeong KY,Min KJ,Woo J,et al.Craniofacial asymmetry in adults with neglected congenital muscular torticollis[J].Ann Rehabil Med,2015,39(3):440-450.DOI:10.5535/arm.2015.39.3.440.
[3] Min KJ,Ahn AR,Park EJ,et al.Effectiveness of surgical release in patients with neglected congenital muscular torticollis according to age at the time of surgery[J].Ann Rehabil Med,2016,40(1):34-42.DOI:10.5535/arm.2016.40.1.34.
[4] Sytsma TT,Terman RW,Brandenburg JE.Custom neck orthosis in combination with onabotulinumtoxinA for the treatment of refractory congenital muscular torticollis:a case report[J].J Pediatr Rehabil Med,2016,9(2):155-158.DOI:10.3233/PRM-160369.
[5] Kim SH,Ahn AR,Yim SY.Congenital muscular torticollis concurrent with sagittal synostosis:a case report[J].Ann Rehabil Med,2014,38(5):712-716.DOI:10.5535/arm.2014.38.5.712.
[6] 赵章帅,唐盛平,熊竹.婴儿先天性肌性斜颈保守综合治疗1142例[J].临床小儿外科杂志,2016,15(6):551-557.DOI:10.3969/j.issn.1671-6353.2016.06.009. Zhao ZS,Tang SP,Xiong Z.Comprehensive treatments of infants with congenital muscular torticollis:a report of 1142 cases[J].DOI:10.3969/j.issn.1671-6353.2016.06.009.
[7] Kim JH,Yum TH,Shim JS.Secondary cervicothoracic scoliosis in congenital muscular torticollis[J].Clin Orthop Surg,2019,11(3):344-351.DOI:10.4055/cios.2019.11.3.344.
[8] Wang JL,Qi W,Liu YJ.Endoscopic release of congenital muscular torticollis with radiofrequency in teenagers[J].J Orthop Surg Res,2018,13(1):100.DOI:10.1186/s13018-018-0801-6.
[9] Kaplan SL,Coulter C,Sargent B.Physical therapy management of congenital muscular torticollis:a 2018 evidence-based clinical practice guideline from the APTA Academy of Pediatric Physical Therapy[J].Pediatr Phys Ther,2018,30(4):240-290.DOI:10.1097/PEP.0000000000000544.
[10] 孔萌,武玉睿,张士松,等.腔镜下胸锁乳突肌切断松解术治疗先天性肌性斜颈的临床分析[J].中国医学创新,2016,13(4):115-118.DOI:10.3969/j.issn.1674-4985.2016.04.033. Kong M,Wu YR,Zhang SS,et al.Clinical analysis of sternocleidomastoid cut loosening for congenital muscular torticollis under laparoscopy[J].Med Innov China,2016,13(4):115-118.DOI:10.3969/j.issn.1674-4985.2016.04.033.
[11] Limpaphayom N,Kohan E,Huser A,et al.Use of combined botulinum toxin and physical therapy for treatment resistant congenital muscular torticollis[J].J Pediatr Orthop,2019,39(5):e343-e348.DOI:10.1097/BPO.0000000000001302.
[12] Sargent B,Kaplan SL,Coulter C,et al.Congenital muscular torticollis:bridging the gap between research and clinical practice[J].Pediatrics,2019,144(2):e20190582.DOI:10.1542/peds.2019-0582.
[13] Kamboh UA,Ashraf M,Zahra SG,et al.Outcome of surgical treatment for neglected congenital muscular torticollis:a series of 28 adolescent patients[J].Surg Neurol Int,2022,13:292.DOI:10.25259/SNI_314_2022.
[14] Pan P.The transaxillary subcutaneous endoscopic sternocleidomastoid muscle division as an approach for the surgical treatment of congenital muscular torticollis in children[J].Indian J Otolaryngol Head Neck Surg,2020,72(1):123-127.DOI:10.1007/s12070-019-01770-3.
[15] Shan JL,Jiang H,Zhang Y,et al.The effectiveness of a novel surgical approach for the treatment of congenital muscular torticollis[J].Medicine (Baltimore),2020,99(14):e19572.DOI:10.1097/MD.0000000000019572.
相似文献/References:
[1]蒋欣李箭刘利君彭明惺唐学阳.儿童单纯性膝关节骨软骨骨折的关节镜治疗[J].临床小儿外科杂志,2011,10(01):0.
JIANG Xin,LI Jian,LIU Li jun,et al.Arthroscopic therapy of osteochondral fractures of the Knee in children.[J].Journal of Clinical Pediatric Surgery,2011,10(07):0.
备注/Memo
收稿日期:2022-12-16。
基金项目:北京市自然科学基金(L222095)
通讯作者:张学军,Email:zhang-x-j04@163.com