兒科學(xué)教學(xué)課件：先天性肌性斜頸

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(dòng)受限)3.Ultrasonography(超聲檢查)32B超

患側(cè)胸鎖乳突肌增厚,回聲增強(qiáng),不均質(zhì)。動(dòng)態(tài)觀測(cè)有不同的變化。4.Histopathology（三）Breechbirth(臀位產(chǎn)史)（四）RuleoutothersAlert:developmentalhipdysplasia

34六.Differentialdiagnosis1.Fracture

ofclavicle

atthetimeofdelivery

(產(chǎn)傷鎖骨骨折)2.Cervicalspinedeformity

(先天性頸椎畸形)OsseoustorticolliscongenitaldysplasiaofcervicalspinescoliosisNocontractureofSternocleidomastoidmuscleCervicalspinedeformity(XrayorCT)3.Atlantoaxialrotarydisplacement(寰樞關(guān)節(jié)旋轉(zhuǎn)移位)CT4.Oculartorticollis(眼源性斜頸)5.Televisionarytorticollis(電視性斜頸）6.Habitualtorticollis(習(xí)慣性斜頸)44

7.Benign

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

disease，2-5

yearsold

pallor,vomitandataxia

8.Softtissueinfectionoftheneck

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

tuberculosis無(wú)胸鎖乳突肌攣縮頸肌普遍性痙攣頭頸活動(dòng)受限病變棘突壓痛寒性膿腫或竇道影像學(xué)見(jiàn)體或盤(pán)破壞臨床表現(xiàn)預(yù)防史、接觸史10.Spasmodictorticollis(痙攣性斜頸)Mentalfactorsmusclespasm不斜頸部顫動(dòng)多見(jiàn)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(shù)）;

aunipolarreleaseatthesternoclavicularormastoidpole;bipolarrelease;middlethirdtransection;completeresection;