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Lee YT Yoon K Kim YB Chung PW Hwang JH Park YS Chung SH Cho SK Han BH 《Journal of pediatric surgery》2011,46(8):1526-1531
Background
It has been reported that ultrasonography (US) can detect the severity of congenital muscular torticollis (CMT), and severe fibrosis of the sternocleidomastoid (SCM) muscle noted on US is irreversible and likely to require surgery. Clinical outcome of CMT depends mainly on the patient's age, which is also associated with the severity of fibrosis as determined by US. However, there has been no well-designed study to elucidate the true relationship among these factors nor a definite consensus on treatment of young infants with severe fibrosis in the SCM compared with well-documented reports that late cases require surgery.Purpose
The purpose of the current study was to investigate whether severity of SCM fibrosis on US is correlated with clinical severity and outcome of standardized physiotherapy in early presenting CMT.Methods
Fifty patients with a palpable neck mass, initial deficit of passive neck rotation (ΔROT) more than 10°, and age less than 3 months were classified into 4 US types according to the severity of fibrosis in the SCM and underwent standardized physiotherapy and regular assessment. Relationship between US types and 2 variables (ΔROT and treatment duration) and success rate of physiotherapy was assessed.Results
None of the cases was classified as type 4. Type 3 showed greatest ΔROT and longest mean treatment duration. Both variables showed a significant linear trend of association with US types by P for trend (P = .003, P < .001, respectively). Treatment was “successful” in 49 patients (98%).Conclusion
In young infants with CMT, US can document severity; and an early and adequate physiotherapy is a good treatment option, particularly even in those with severe fibrosis. 相似文献2.
α-SMA在先天性肌性斜颈中的表达及意义 总被引:5,自引:0,他引:5
目的 :研究α 平滑肌肌动蛋白 (alpha smoothmuscleactin ,α SMA)在先天性肌性斜颈 (congen italmusculartorticollis,CMT)中的表达及意义。方法 :利用免疫组化辅以计算机图象定量分析技术 ,对2 1例先天性肌性斜颈及 10例正常肌肉腱性组织标本α SMA的表达进行观察和检测。结果 :α SMA在对照组中未见明显表达 ,3例先天性肌性斜颈标本α SMA染色阴性 ,18例病变标本中α SMA染色阳性 ,病变组与对照组两者差异有非常显著性意义 (P <0 0 0 1) ;α SMA在肌性斜颈中表达强度与年龄有关 ,6岁以上组表达明显减弱 ,与 6岁以下组 (包括 6岁 )比较差异有显著性意义 (P <0 0 0 1)。结论 :①肌纤维母细胞是先天性肌性斜颈发病关键病理因素。②先天性肌性斜颈中肌纤维母细胞的表达在 6岁以上组明显减弱 ,这给临床治疗提供新思路 相似文献
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Masahide Amemiya Ichiro Kikkawa Hideaki Watanabe Yuichi Hoshino 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2009,19(5):303-307
The objective of this study is to review the clinical course after surgical treatment of congenital muscular torticollis and
investigate the problems. Based on the treatment strategy of our institution for patients with congenital muscular torticollis,
we treated young children with unipolar tenotomy of the sternocleidomastoid muscle, with postoperative use of our original
brace, and school age or older children with bipolar tenotomy of the sternocleidomastoid muscle and postoperative use of a
simple immobilizing brace, mainly a Philadelphia collar. This study included nine patients who underwent unipolar or bipolar
tenotomy of the sternocleidomastoid muscle in our department between November 1990 and April 2006. Of these, four were boys
and five were girls. Seven had right and two had left torticollis. The age at surgery ranged from 1 year 6 months to 24 years.
Five underwent unipolar tenotomy and four underwent bipolar tenotomy. The study period from the first visit to the present
ranged from 1 year 6 months to 18 years 9 months. The evaluation was based on the presence of recurrence and the assessment
criteria described by Tanabe (Arch Orthop Trauma Surg 122:489–493, 2002). Three of five patients treated with unipolar tenotomy
had a second surgery due to recurrence. None of those treated with bipolar tenotomy experienced recurrence. According to Tanabe’s
criteria, among the five patients treated with unipolar tenotomy, two were graded as excellent, two fair, and one poor. And
among the four treated with bipolar tenotomy, three were graded as excellent and one fair. Although this study included only
nine patients treated and followed-up, more than half of those treated with unipolar tenotomy of the sternocleidomastoid muscle
experienced recurrence requiring further surgery. Among those treated with bipolar tenotomy, the outcomes were generally good,
and no recurrence was observed. Unipolar tenotomy of the sternocleidomastoid muscle in young children requires special attention
with regard to recurrence. We decided to conduct bipolar tenotomy in young children and investigate future outcomes. 相似文献
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目的 探讨高原严重多发伤并发多脏器功能障碍综合征(multiple organ dysfunction syndrome,MODs)的危险因素及治疗策略.方法 回顾性分析2003年1月-2004年12月及2005年1月~2007年12月分别收住我院ICU的严重多发伤患者93例和98例,前者为A组,后者为B组.对两组患者的年龄、性别、急性生理与慢性健康评分(acute physiology and chronic healthy score,APACHE Ⅱ)、创伤严重度评分(injury severity score,ISS)、低氧血症、休克、脓毒症、凝血障碍、腹腔室隔综合证(abdomer compartment syndrome,ACS)、急性肾功能衰竭、高血糖等因素进行logstic分析,同时分析不同处理方式对严重创伤病死率的影响.结果 A组和B组中分别有45(45/93)例和48例(48/98)严重创伤患者早期并发MODS,这些患者在休克、低氧血症、脓毒血症、ACS、凝血障碍、APACHEⅡ评分、ISS评分方面明显高于无MODS患者.差异有统计学意义(P<0.01).B组患者由于治疗策略转变,除治疗原发病外.还采用了早期液体足量复苏、纠正休克、纠正凝血紊乱、早期机械通气、目标血糖控制、充分镇静镇痛、抑制炎症反应、伴腹腔高压者早期行腹腔引流等措施,其病死率下降,与A组比较,差异有统计学意义(P<0.01).经相关危险冈素分析,休克、低氧血症、脓毒血症是MODS发生的主要因素(P相似文献