Wang Fei,Zhang Jing,Ni Lei,et al.Sonographic outcomes of sternomastoid tumor after manual stretching for congenital muscular torticollis in children[J].Journal of Clinical Pediatric Surgery,2024,(10):958-964.[doi:10.3760/cma.j.cn101785-202101026-011]
先天性肌性斜颈手动牵拉治疗后胸锁乳突肌包块的影像学转归规律研究
- Title:
- Sonographic outcomes of sternomastoid tumor after manual stretching for congenital muscular torticollis in children
- Keywords:
- Congenital Muscular Torticollis; Sternomastoid Tumor; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨先天性肌性斜颈(congenital muscular torticollis, CMT)患儿手动牵拉治疗后胸锁乳突肌(sternocleidomastoid, SCM)包块的转归规律。方法 本研究为回顾性研究, 将2017年5月至2019年5月在南京医科大学附属儿童医院骨科就诊的209例存在SCM包块的CMT患儿作为研究对象。患儿均采用手动牵拉治疗, 初诊月龄均在3个月以内, 均获3次以上随访。按性别分组:男132例, 女77例。比较不同性别间初诊日龄、包块侧别分布以及包块的长径、短径与横截面积。按就诊次数, 209例有3次就诊, 其中71例有4次就诊。比较第1、2、3、4次就诊时包块长径、短径及横截面积。按照初诊或复诊时月龄, 1月龄141例、2月龄67例、3月龄91例、4月龄51例、5月龄49例、6月龄58例、7月龄32例、8月龄39例、9月龄22例、10月龄16例、11月龄11例、12月龄118例、大于12月龄15例。比较不同月龄时包块长径、短径及横截面积。按照"6月龄以内B超发现包块已消失"、"6月龄以上B超发现包块已消失"以及"末次随访时仍未提示包块已消失"将患儿分为Ⅰ组(82例)、Ⅱ组(105例)、Ⅲ组(21例)。比较Ⅰ组、Ⅱ组、Ⅲ组间患儿性别分布、包块侧别分布、初诊日龄、随访时间及初诊包块长径、短径及横截面积。结果 所纳入的209例CMT患儿初诊时SCM包块长径为(28.8±5.6)mm, 短径为(12.5±2.4)mm, 横截面积为(288.5±94.9)mm2。男性、女性患儿初诊日龄[(37.2±19.1)d比(37.7±20.2)d ]、初诊包块长径[ (29.0±5.6)mm比(28.6±5.6)mm]、初诊包块短径[(12.6±2.4)mm比(12.2±2.3)mm]和横截面积[(293.5±96.8)mm2比(280.0±91.0)mm2]差异均无统计学意义(P＞0.05)。随着就诊次数和患儿月龄的增加, 包块长径[第1次(28.9±5.6)mm, 第2次(17.1±14.0)mm, 第3次(5.9±11.4)mm, 第4次(1.0±5.2)mm]、短径[第1次(12.4±2.4)mm, 第2次(7.1±5.8)mm, 第3次(2.4±4.7)mm, 第4次(0.4±2.3)mm]及横截面积[第1次(288.1±94.4)mm2, 第2次(157.6±146.4)mm2, 第3次(52.1±109.1)mm2, 第4次(9.4±53.7)mm2]呈逐渐减小趋势(P＜0.05)。6~12月龄的患儿中, B超提示包块已消失的比例分别为40.3%(83/206)和94.3%(181/192)。分组比较Ⅰ、Ⅱ、Ⅲ组初诊日龄[(36.0±18.9)d, (38.4±20.6)d, (37.1±14.0)d]、包块左侧、右侧分布(36 ∶46, 49 ∶56, 10 ∶11)、初诊包块长径[(28.5±5.4)mm, (28.7±5.8)mm, (30.7±5.0)mm]差异无统计学意义(P＞0.05), 而初诊包块短径[(11.9±2.3)mm, (12.6±2.3)mm, (13.6±2.4)mm]、初诊包块横截面积[(273.5±90.6)mm2, (291.3±94.4)mm2, (335.0±98.5)mm2]差异有统计学意义(P＜0.05)。Ⅰ、Ⅱ、Ⅲ组男性与女性比例有逐渐增大趋势(48 ∶35, 68 ∶37, 16 ∶5), 但差异无统计学意义(P=0.277)。Ⅲ组患儿初诊包块短径[(13.6±2.4)mm比(11.9±2.3)mm]及横截面积[(335.0±98.5)mm2比(273.5±90.6)mm2]明显大于Ⅰ组(P＜0.05), 随访时间[(6.9±2.3)个月 比(10.7±3.1)个月]短于Ⅱ组(P＜0.05)。男性、女性患儿B超发现包块已消失时间分别为(8.7±4.4)个月及(7.5±3.3)个月, 差异有统计学意义(P＜0.05)。结论 存在SCM包块的CMT患儿在3月龄内开始牵拉治疗, 90%以上患儿的SCM包块可在1岁以内消失;男性患儿B超发现包块消失时间晚于女性;加强治疗宣教及提高复诊依从性可更准确地评估包块转归过程。
- Abstract:
- Objective To explore the impact of manual stretching on the size changes of sternomastoid (SCM) tumor in congenital muscular torticollis (CMT). Methods Between May 2017 and May 2019, retrospective review was conducted for 209 CMT children with SCM tumor. There were 132 males and 77 females, respectively. The side of involvement, the first visiting age and the initial long diameter, short diameter and cross section area of the SCM tumor were compared between sexes. Three visits were recorded in 209 patients, of whom 71 had four visits. The long diameter, short diameter and cross section area of the SCM tumor were compared between different visits. According to the age at visiting, 141 cases were 1 month old, 67 cases were 2 months old, 91 cases were 3 months old, 51 cases were 4 months old, 49 cases were 5 months old, 58 cases were 6 months old, 32 cases were 7 months old, 39 cases were 8 months old, 22 cases were 9 months old, 16 cases were 10 months old, 11 cases were 11 months old, 118 cases were 12 months old, and 15 cases were older than 12 months old. The long diameter, short diameter and cross section area of the SCM tumor were compared between different age. The patients were divided into three groups according to the age when ultrasound demonstrated the tumor disappeared. Group Ⅰ:≤ 6 months; Group Ⅱ:>6 months; Group Ⅲ:Still not disappeared at the final follow up. The demographic information, the initial long diameter, short diameter and cross section area of the SCM tumor and the total follow up time were compared within three groups. Results Initial long diameter, short diameter and cross-section area were (28.8±5.6)mm, (12.5±2.4)mm and (288.5±94.9)mm2 respectively.No gender differences existed in initial visiting age [(37.2±19.1) vs.(37.7±20.2) day, P=0.669], initial long diameter [(29.0±5.6) vs.(28.6±5.6)mm, P=0.818], short diameter [(12.6±2.4) vs.(12.2±2.3)mm, P=0.640] or cross-section area [(293.5±96.8) vs.(280.0±91.0) mm2, P=0.458].Long diameter [first time (28.9±5.6), second time (17.1±14.0), third time (5.9±11.4), fourth time (1.0±5.2)mm, P<0.001], short diameter [first time (12.4±2.4) second time (7.1±5.8), third time (2.4±4.7), fourth time (0.4±2.3)mm, P<0.001] and cross section area [first time (288.1±94.4), second time (157.6±146.4), third time (52.1±109.1), fourth time (9.4±53.7)mm2, P<0.001] decreased gradually with elapsing visiting time and age.And 40.3% of tumors disappeared until an age of 6 months and this ratio spiked to 94.3% at Month 12.No differences existed in initial visiting age [((36.0±18.9) vs.(38.4±20.6) vs.(37.1±14.0)day, P=0.701], left/right involved side [36 ∶46, 49 ∶56, 10 ∶11, P=0.918] or initial long diameter [(28.5±5.4) vs.(28.7±5.8) vs.(30.7±5.0)mm, P=0.286] among three groups.Meanwhile, short diameter [(11.9±2.3) vs.(12.6±2.3) vs.(13.6±2.4)mm, P=0.007] and cross-section area [(273.5±90.6) vs.(291.3±94.4) vs.(335.0±98.5)mm2, P=0.027] differed statistically among three groups.Gender ratio (male:female) increased from group Ⅰ to group Ⅲ (48 ∶35, 68 ∶37, 16 ∶5).However, the difference was insignificant (P=0.277).Group Ⅲ had greater initial short diameter [(13.6±2.4) vs.(11.9±2.3)mm, P<0.05] and cross section area [(335.0±98.5) vs.(273.5±90.6)mm2, P<0.05] than Group Ⅰand yet shorter follow-up time [(6.9±2.3) vs.(10.7±3.1)m, P<0.05] than Group Ⅱ.Average age of disappearing tumor was greater in boys and that in girls [(8.7±4.4) vs.(7.5±3.3)m, P<0.05]. Conclusions More than 90% of SCM tumors in CMT children may disappear within an age of 1 year if manual stretching is initiated within 3 months.Tumors disappear later in boys than girls.The dynamic process of SCM tumor may be evaluated more accurately after improving health tutoring and boosting follow-up compliance.
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备注/Memo
收稿日期:2021-1-11。
基金项目:南京市卫生科技发展专项资金项目(YKK20123)
通讯作者:唐凯,Email:tk603@sina.com