CongenitalMuscularTorticollis

先天性肌性斜頸2Objective:

Tomastertheclinicalmanifestations,diagnosis,differentialdiagnosisandtreatmentofcongenitalmusculartorticollis.Keypoint:Theclinicalmanifestations,diagnosis,differentialdiagnosisandtreatmentofcongenitalmusculartorticollis.Difficultpoint:Thediagnosisanddifferentialdiagnosisofcongenitalmusculartorticollis.3Introduction1.Congenitalmusculartorticollis,orcongenitalwryneck,isthemostcommoncauseoftorticollisintheinfantandyoungchild.2.

Thedeformityiscausedbycontracture(攣縮）

ofthesternocleidomastoid

muscle,withtheheadtiltedtowardtheinvolvedsideandthechinrotatedtowardtheoppositeshoulder.

3.Mobidity

isabout3-5‰.4.80%ofcasesoccurontherightside

.5.Ifthedeformityisprogressive,skullandfacedeformitiescandevelop.6.upto20%ofcaseshavedevelopmentalhipdysplasia.6

unilateralmovementTheheadtiltedtowardtheinvolvedsideandthechinrotatedtowardtheoppositeshoulder.

bilateralmovementanteflexionAnatomyandfounction7二.Etiology（一）Directreason：sternocleidomastoidmusclefibrosis

and

contracture(纖維化、攣縮)（二）Why?Theexactcauseisunclear。8（三）SeveraltheoriesBirthtrauma（1）Hemorrhage

sternocleidomastoidmusclewastore

hematoma

musclefibrosis

contracture

（2）Prolonglabourischemiaofsternocleidomastoidmuscle

degenerationandfibrosisofmusclefibers

torticollis2.

Insufficientbloodsupply

singlebloodsupply

venousocclusion

malpresentationinuterotheheadtiltedtowardtheonesidesofttissuecompressionoftheneckischemia、fibrosisandcontractureofsternocleidomastoidmuscletorticollis3.Congenitalmalformation

4.Acompartmentsyndrome

ofthesternocleidomastoidmuscle

occurs(胸鎖乳突肌筋膜室綜合征的后遺癥)

5.

Geneticpredisposition17三.Pathology（一）＜1yearold1.A

massor“tumor”maybepalpableintheneck

(腫塊）.2.Histopathology

（1）likefibroma（纖維瘤）（2）edema,degenerationofmusclefibers,andmusclefibrosis.

without

hemosiderosis;（3）myoblastsandfibroblastsinsternocleidomastoid“tumors”.（二）＞1yearold1.Lumpgraduallyregresses;2.fibrosisandcontracture（纖維化和攣縮）ofthesternocleidomastoidmuscle.23四.Clinicalmanifestation（一）＜1yearold1.Lump（腫塊）isanontender,softenlargementbeneaththeskin,andislocatedwithinthesternocleidomastoidmusclebelly.

2.“Tumor”

reachesitsmaximumsizewithinthefirst4weeksoflifethengraduallyregresses.After4to6monthsoflifethecontractureandthetorticollisaretheonlyclinicalfindings

（攣縮+斜頸）.3.Ifthe

deformityisprogressive,skullandfacedeformitiescandevelop(骨骼和面部畸形）

.（二）＞1yearold1.Thedeformityisprogressive:

theheadtiltedtowardtheinvolvedsideandthechinrotatedtowardtheoppositeshoulder(頸部畸形加重).

2.

Facial

deformityoralimitationofmotion,andfurtherfacialflatteningandfurthercosmeticdeterioration(面部畸形加重）

.3.The

leveloftheeyesandearsbecomesunequalandcanresultinconsiderablecosmeticdeformity.

27

ABCcanthus—angulusoris

(A)、tragus—apexnasi(B)、lobulusauriculae--acromion(C)4.Cervical

spinedeformity(頸椎畸形）

五.

Diagnosis（一）Torticollis(頸部偏斜)（二）Sternocleidomastoidmusclelesions1.Lump(腫塊)2.The

contractureandalimitationofmotion(攣縮+活動受限)3.Ultrasonography(超聲檢查)32B超

患側胸鎖乳突肌增厚,回聲增強,不均質。動態觀測有不同的變化。4.Histopathology（三）Breechbirth(臀位產史)（四）RuleoutothersAlert:developmentalhipdysplasia

34六.Differentialdiagnosis1.Fracture

ofclavicle

atthetimeofdelivery

(產傷鎖骨骨折)2.Cervicalspinedeformity

(先天性頸椎畸形)OsseoustorticolliscongenitaldysplasiaofcervicalspinescoliosisNocontractureofSternocleidomastoidmuscleCervicalspinedeformity(XrayorCT)3.Atlantoaxialrotarydisplacement(寰樞關節旋轉移位)CT4.Oculartorticollis(眼源性斜頸)5.Televisionarytorticollis(電視性斜頸）6.Habitualtorticollis(習慣性斜頸)44

7.Benign

paraxysmaltorticollis,BPT(嬰兒良性陣發性斜頸)self-limited

disease，2-5

yearsold

pallor,vomitandataxia

8.Softtissueinfectionoftheneck

softtissueinfectiontemporarytorticollis頸部B超、血常規局部腫脹、壓痛全身癥狀9.Tuberculosisortumor

tuberculosis無胸鎖乳突肌攣縮頸肌普遍性痙攣頭頸活動受限病變棘突壓痛寒性膿腫或竇道影像學見體或盤破壞臨床表現預防史、接觸史10.Spasmodictorticollis(痙攣性斜頸)Mentalfactorsmusclespasm不斜頸部顫動多見成年人11.Cerebralpalsy(腦癱)Differentialdiagnosticchart

torticollisFacialdeformityYesNoCongenitalmusculartorticollisCervicalspinedeformityOculartorticollisHabitualtorticollisAtlantoaxialrotarydisplacementBPTSpasmodictorticollisOthers七.Treatment（一）<1yearold

Conservative:1.手法治療aregimenofstretchingexercisesandroommodifications2.局部激素注射（二）Surgicalrelease1.

Theoptimaltime:1~2yearsold2.Methods:partial

muscularsternocleidomastoideustomy（胸鎖乳突肌部分切除術）;

aunipolarreleaseatthesternoclavicularormastoidpole;bipolarrelease;middlethirdtransection;completeresection;