Risk factors for intrauterine constraint are associated with ultrasonographically detected severe fibrosis in early congenital muscular torticollis |
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Authors: | Lee Yong-Taek Cho Soo Kyoung Yoon Kyungjae Shin Hun Kyu Kim Eugene Kim Yong-Bum Kim Won-Serk Chun Jung Mi Han Byung Hee |
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Institution: | a Department of Rehabilitation Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul 110-746, South Koreab Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul 110-746, South Koreac Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul 110-746, South Koread Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul 110-746, South Koreae Department of Pediatrics, Cheil General Hospital, Kwandong University, School of Medicine, Seoul 100-380, South Koreaf Department of Radiology, Cheil General Hospital, Kwandong University, School of Medicine, Seoul 100-380, South Korea |
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Abstract: | Background/PurposeThe etiology of congenital muscular torticollis (CMT) remains controversial. Ultrasonographically, severe fibrosis involving the entire sternocleidomastoid muscle (SCM; type 3 or 4) fibrosis has been associated with poor clinical outcomes and indicates a chronic state of the condition. The purpose of this study was to test whether or not type 3 or 4 fibrosis detected early after birth is associated with factors related to prolonged intrauterine constraint.MethodsSixty-seven patients (age, <3 months) with CMT were classified into 4 different ultrasonographic types according to the severity of SCM fibrosis. The odds ratio for the relationship between probability of type 3 or 4 and factors related to intrauterine constraint were calculated by a multivariate logistic regression model.ResultsNone were classified as type 4. Twenty-three patients (34%) had a history of breech presentation, and 21 (91.3%) of them were delivered by elective cesarean section without likelihood of birth trauma. Compared with normal pregnancy, breech presentation and oligohydramnios showed a 6.7 or 7.5 times higher probability for type 3 fibrosis, respectively.ConclusionRisk factors for intrauterine constraint appear to be associated with ultrasonographically detected severe fibrosis involving the entire SCM muscle in early presenting CMT. |
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Keywords: | Congenital muscular torticollis Etiology Ultrasonography Breech presentation Intrauterine constraint |
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