内镜下胸锁乳突肌切断治疗肌性斜颈的疗效观察

目的探讨内镜下离断胸锁乳突肌治疗肌性斜颈的效果。方法23例肌性斜颈患儿,年龄1个月～12岁,中位数2岁6个月。右侧腋窝皮纹线内置入5mm trocar,手持镜头将胸锁乳突肌下端胸骨头和锁骨头表面的肌膜钝性分离,充入CO2气体加压至6mmHg,形成皮下空间。在外侧颈下横纹内和前胸横纹处切开3mm分别置入3mm弯钳和电刀尖。电凝或电切横断胸锁乳突肌纤维束,松解胸锁乳突肌周围的纤维组织。结果23例均在内镜下完成手术。平均手术时间51．2min（35～135min）,术中出血量均〈1ml。无损伤周围大血管和神经。1例颈部切口处皮肤轻微电灼伤,2周后自愈。术后行颈部舒展活动训练,术后第1天出院。23例随访3个月～4年,中位时间6个月,斜颈均矫正,疗效优18例,良5例,切口瘢痕不明显,皮肤弹性好,随表情无异常活动现象,无复发。结论内镜下胸锁乳突肌切断治疗肌性斜颈具有微创、恢复快、效果好的优点,瘢痕不明显,美观且不损伤颈阔肌,对表情活动无影响。

Endoscopic sternocleidomastoid muscle amputation for the treatment of congenital muscular torticollis

Objective To investigate curative effects of endoscopic sternocleidomastoid muscle amputation for the treatment of congenital muscular torticollis.Methods A total of 23 children with congenital muscular torticollis were treated in this department.Their age was 1 month ~ 12 years old(median,30 months).A 5 mm trocar was inserted through the right axilla along the cleavage lines.Under the endoscopic visualization,the sarcolemma on the inferior portion of the muscle was bluntly dissected and a subcutaneous space was established by CO_2 inflation at the pressure of 6 mm Hg.Another two 3 mm incisions were made along the cleavage lines at lower lateral part of the neck and the anterior chest wall for the introduction of curved forceps and electric knife,respectively.The sternocleidomastoid muscle was transected with electrocautery and the external fascia within which the sternocleidomastoid muscle resides was also adequately divided. Results The operation was successfully completed under endoscope in all the 23 children.The mean operation time was 51.2 min(range,(35~)135 min) and the intraoperative blood loss was < 1 ml.No injuries of major blood vessels or nerves were encountered.Slight electric burn was noted in 1 child and healed up after two weeks.All the children were instructed for cervical exercises and were discharged from hospital on the first day postoperatively.Follow-up checkups for 3 months ~ 4 years(median,6 months) in all the patients showed satisfactory cosmetic appearance and no recurrence.The curative effects were classified as "excellent" in 18 children and "good" in 5 children.Conclusions Endoscopic sternocleidomastoid muscle amputation fr the treatment of muscular torticollis bears advantages of minimal invasion,little pain,quick recovery,high efficacy,and good cosmetic outcomes.The facial expression is unaffected.