Clinical analysis and prognosis of reoperation of congenital muscular torticollis in 12 children
10.3760/cma.j.cn101070-20200809-01320
- VernacularTitle:先天性肌性斜颈再手术12例临床分析及预后
- Author:
Xianyong LUO
1
;
Xinrang CHEN
;
Jiaxiang WANG
Author Information
1. 郑州大学第一附属医院小儿外科 450052
- Keywords:
Congenital muscular torticollis;
Recurrence;
Two-stage release
- From:
Chinese Journal of Applied Clinical Pediatrics
2021;36(23):1782-1785
- CountryChina
- Language:Chinese
-
Abstract:
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.
