小儿肌性斜颈和眼性斜颈的鉴别诊断与手术治疗探讨

目的探讨小儿肌性斜颈和眼性斜颈的鉴别诊断与手术治疗。方法通过对在该院进行治疗的60例肌性斜颈和眼性斜颈患儿,根据病情进行分组,每组为30例患者,患儿经彩色超声和眼科检查,按照患儿病情采取手术治疗。观察比较两组患儿的临床检查结果和治疗效果,同时对患儿的面容和颈部功能进行分析。结果肌性斜颈患儿胸锁乳突肌明显增厚,回声加强,边界不清晰,病变区域血流量减少。眼性斜颈患儿胸锁乳突肌检查正常,内部条纹整齐规则,血流信号丰富;眼性斜颈患儿眼肌麻痹,14例患儿上斜肌麻痹,16例患儿上直肌麻痹;肌性斜颈组患儿与眼性斜颈组患儿治疗效果差异无统计学意义（P〉0.05）;肌性斜颈组患儿的面容和颈部功能较眼性斜颈组患儿明显改善,差异有统计学意义（P〈0.05）。结论彩色超声和眼科检查可以有效鉴别小儿肌性斜颈和眼性斜颈,根据患儿病情采取手术治疗,可以获得良好的治疗效果,肌性斜颈的预后较眼性斜颈预后略增强。

Discussion on the Differential Diagnosis Between Pediatric Muscular Torticollis and Pediatric Ocular Torticollis and the Surgical Treatment

Objective To investigate the differential diagnosis between pediatric muscular torticollis and pediatric ocular torticollis and the surgical treatment. Methods 60 cases of children with muscular torticollis or ocular torticollis treated in our hospital from June, 2011 to June, 2013 were divided into two groups with 30 cases in each according to the state of illness. Color Doppler ultrasound and ophthalmologic examination were performed in the patients. And surgical treatment was given to the patients according to the patient＇s condition. The results of clinical examination and treatment effect of two groups of children were observed and compared, and the face and neck functions of the children were analyzed. Results The sternocleidomastoid muscle examination of children with muscular torticollis thickened significantly with strengthened echo, unclear boundary, and reduction of blood flow in the lesion area. The sternocleidomastoid muscle examination of children with ocular torticollis was normal with internal neat and regular stripes and rich blood flow signals; ophthalmoparalysis was found in the children with ocular torticollis, 14 patients with superior oblique palsy, and 16 cases of children with the superior rectus paralysis; the difference in treatment effect between pediatric muscular torticollis group and pediatric ocular torticollis group was not statistically significant（P〉0.05）; compared with the pediatric ocular torticollis group, the face and neck functions in children with muscular torticollis group improved more significantly,the difference between the two groups was statistically significant（P〈0.05）. Conclusion Color Doppler ultrasound and ophthalmologic examination can effectively differentiate between pediatric muscular torticollis and pediatric ocular torticollis, the children can be given surgical treatment based on the state of the illness so that good treatment effect can be achieved, and the prognosis of muscular torticollis is slightly better than that of ocular torticollis.