ICF-CY框架下先天性肌性斜颈的评估与综合治疗

doi:10.3877/cma.j.issn.1674-0785.2019.01.015

先天性肌性斜颈（CMT）是因一侧胸锁乳突肌短缩引起头向患侧歪，面部向对侧旋转的疾病。对于1岁以下患儿往往通过手法牵伸、包块按摩等物理治疗手段进行干预，常通过目测或角度测量进行评估，尚无统一的评估及物理治疗标准。《国际功能、残疾和健康分类（儿童和青少年版）》（ICF-CY）为目前国际通用的记录和描述儿童和青少年功能、残疾和健康状况的工具，强调疾病或健康的状态是由身体结构与功能、活动、参与以及环境因素综合作用所决定，对于疾病需要整体分析、综合干预。为更好理解CMT，本文按照ICF-CY的框架对CMT评估及物理治疗做一综述。

关键词: 先天性肌性斜颈, 国际功能、残疾和健康分类（儿童和青少年版）, 评估, 治疗

Congenital muscular torticollis (CMT) is typically characterized by lateral ?exion of the head to one side and cervical rotation to the opposite side due to unilateral shortening of the sternocleidomastoid muscle. Infants with CMT under the age of 1 year old are frequently treated with physical therapy, such as manual stretching and mass massage, and are evaluated by visual or angular measurement. However, there are no consensus on the techniques to perform the physical therapy examination and intervention. The International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY) is an international tool for recording and describing the functions, disability, and health status of children and adolescents, emphasizing that the condition of the disease or health is determined by the combination of body structure and function, activity, participation, and environmental factors, and the treatment of this disease requires overall analysis and integrated intervention. This article applies the ICF-CY framework to review the physical therapy examination and intervention of CMT.

Key words: Congenital muscular torticollis, International Classification of Functioning, Disability and Health-Children and Youth Version, Physical therapy examination, Therapy

表1 肌肉功能检查量表

得分	头与躯干的关系	头与躯干水平线的夹角
0	头在躯干水平线以下	＜0°（头在躯干水平线以下）
1	头与躯干水平线重叠	0°（头与躯干水平线重叠）
2	头略高于躯干水平线	0~15°（头在躯干水平线以上）
3	头明显高于躯干水平线，＜45°	15°~45°（头在躯干水平线以上）
4	头明显高于躯干水平线，＞45°	45°~75°（头在躯干水平线以上）
5	头接近垂直位	＞75°（头在躯干水平线以上）

表1 肌肉功能检查量表

得分	头与躯干的关系	头与躯干水平线的夹角
0	头在躯干水平线以下	＜0°（头在躯干水平线以下）
1	头与躯干水平线重叠	0°（头与躯干水平线重叠）
2	头略高于躯干水平线	0~15°（头在躯干水平线以上）
3	头明显高于躯干水平线，＜45°	15°~45°（头在躯干水平线以上）
4	头明显高于躯干水平线，＞45°	45°~75°（头在躯干水平线以上）
5	头接近垂直位	＞75°（头在躯干水平线以上）

表2 2013美国儿童物理治疗协会CMT CPG中CMT分级

分级	就诊年龄	临床表现
1级	0~6个月	姿势性斜颈；或患侧胸锁乳突肌紧张、双侧颈部旋转角度差＜15°
2级	0~6个月	患侧胸锁乳突肌紧张、双侧颈部旋转角度差15°~30°
3级	0~6个月	患侧胸锁乳突肌紧张、双侧颈部旋转角度差＞30°；或胸锁乳突肌存在包块
4级	7~9个月	姿势性斜颈；或患侧胸锁乳突肌紧张、双侧颈部旋转角度差＜15°
5级	10~12个月	姿势性斜颈；或患侧胸锁乳突肌紧张、双侧颈部旋转角度差＜15°
6级	7~12个月	患侧胸锁乳突肌紧张、双侧颈部旋转角度差＞15°
7级	＞7个月	存在胸锁乳突肌包块；或年龄＞12个月、双侧颈部旋转角度差＞30°

表2 2013美国儿童物理治疗协会CMT CPG中CMT分级

分级	就诊年龄	临床表现
1级	0~6个月	姿势性斜颈；或患侧胸锁乳突肌紧张、双侧颈部旋转角度差＜15°
2级	0~6个月	患侧胸锁乳突肌紧张、双侧颈部旋转角度差15°~30°
3级	0~6个月	患侧胸锁乳突肌紧张、双侧颈部旋转角度差＞30°；或胸锁乳突肌存在包块
4级	7~9个月	姿势性斜颈；或患侧胸锁乳突肌紧张、双侧颈部旋转角度差＜15°
5级	10~12个月	姿势性斜颈；或患侧胸锁乳突肌紧张、双侧颈部旋转角度差＜15°
6级	7~12个月	患侧胸锁乳突肌紧张、双侧颈部旋转角度差＞15°
7级	＞7个月	存在胸锁乳突肌包块；或年龄＞12个月、双侧颈部旋转角度差＞30°

1	Suhr MC, Oledzka M. Considerations and intervention in congenital muscular torticollis [J]. Curr Opin Pediatr, 2015, 27(1): 75-81.
2	Cheng JC, Tang SP, Chen TM. Sternocleidomastoid pseudotumor and congenital muscular torticollis in infants: a prospective study of 510 cases [J]. J Pediatr, 1999, 134(6): 712-716.
3	Bredenkamp JK, Hoover LA, Berke GS, et al. Congenital muscular torticollis. A spectrum of disease [J]. Arch Otolaryngol Head Neck Surg, 1990, 116(2): 212-216.
4	董涵宇，杜琳，单玲, 等. ICF-CY与儿童康复 [J/CD]. 中华临床医师杂志(电子版), 2014, 8(21): 3892-3896.
5	Kaplan SL, Coulter C, Fetters L. Physical therapy management of congenital muscular torticollis: an evidence-based clinical practice guideline: from the Section on Pediatrics of the American Physical Therapy Association [J]. Pediatr Phys Ther, 2013, 25(4): 348-394.
6	Ohman AM, Nilsson S, Beckung ER. Validity and reliability of the muscle function scale, aimed to assess the lateral flexors of the neck in infants [J]. Physiother Theory Pract, 2009, 25(2): 129-137.
7	Lee K, Chung E, Koh S, et al. Outcomes of asymmetry in infants with congenital muscular torticollis [J]. J Phys Ther Sci, 2015, 27(2): 461-464.
8	Hong SK, Song JW, Woo SB, et al. Clinical usefulness of sonoelastography in infants with congenital muscular torticollis [J]. Ann Rehabil Med, 2016, 40(1): 28-33.
9	Han MH, Kang JY, Do HJ, et al. Comparison of clinical findings of congenital muscular torticollis between patients with and without sternocleidomastoid lesions as determined by ultrasonography [J]. J Pediatr Orthop, 2017 Aug 2. [Epub ahead of print]
10	Jung AY, Kang EY, Lee SH, et al. Factors that affect the rehabilitation duration in patients with congenital muscular torticollis [J]. Ann Rehabil Med, 2015, 39(1): 18-24.
11	Golden KA, Beals SP, Littlefield TR, et al. Sternocleidomastoid imbalance versus congenital muscular torticollis: their relationship to positional plagiocephaly [J]. Cleft Palate Craniofac J, 1999, 36(3): 256-261.
12	Cheng JC, Tang SP, Chen TM, et al. The clinical presentation and outcome of treatment of congenital muscular torticollis in infants-a study of 1,086 cases [J]. J Pediatr Surg, 2000, 35(7): 1091-1096.
13	Schertz M, Zuk L, Zin S, et al. Motor and cognitive development at one-year follow-up in infants with torticollis [J]. Early Hum Dev, 2008, 84(1): 9-14.
14	Onay T, Gumustas SA, Caqirmaz T, et al. Do the risk factors for developmental dysplasia of the hip differ according to gender? A look from another perspective [J]. J Paediatr Child Health, Epub 2018 Aug 1.
15	Tien YC, Su JY, Lin GT, et al. Ultrasonographic study of the coexistence of muscular torticollis and dysplasia of the hip [J]. J Pediatr Orthop, 2001, 21(3): 343-347.
16	Joiner ER, Andras LM, Skaggs DL. Screening for hip dysplasia in congenital muscular torticollis: is physical exam enough? [J]. J Child Orthop, 2014, 8(2): 115-119.
17	McClure P, Podeszwa DA. Hip click in the neonate: should I be concerned? [J]. Pediatr Ann, 2016, 45(4): e122-e127.
18	Hussein MA, Yun IS, Lee DW, et al. Cervical Spine Dysmorphism in Congenital Muscular Torticollis [J]. J Craniofac Surg, 2018: 29(4): 925-929.
19	王娜，张遇乐，关步云, 等. 小儿发育性髋关节发育不良与先天性肌性斜颈的超声筛查 [J]. 南方医科大学学报, 2017, 37(7): 924-928.
20	Bhaskar A, Harish U, Desai H. Congenital muscular torticollis: use of gaze angle and translational deformity in assessment of facial asymmetry [J]. Indian J Orthop, 2017, 51(2): 123-130.
21	Watemberg N, Bensasson A, Goldfarb R. Transient motor asymmetry among infants with congenital torticollis-description, characterization, and results of follow-up [J]. Pediatr Neurol, 2016, 59: 36-40.
22	Cabrera-Martos I, Valenza MC, Valenza-Demet G, et al. Impact of torticollis associated with plagiocephaly on infants’ motor development [J]. J Craniofac Surg, 2015, 26(1): 151-156.
23	Ohman A, Nilsson S, Lagerkvist AL, et al. Are infants with torticollis at risk of a delay in early motor milestones compared with a control group of healthy infants? [J]. Dev Med Child Neurol, 2009, 51(7): 545-550.
24	de Chalain TM, Park S. Torticollis associated with positional plagiocephaly: a growing epidemic [J]. J Craniofac Surg, 2005, 16(3): 411-418.
25	Stellwagen L, Hubbard E, Chambers C, et al. Torticollis, facial asymmetry and plagiocephaly in normal newborns [J]. Arch Dis Child, 2008, 93(10): 827-831.
26	Lal S, Abbasi AS, Jamro S. Response of primary torticollis to physiotherapy [J]. J Surg Pakistan, 2011, 16(4): 153-156.
27	Lam S, Pan IW, Strickland BA, et al. Factors influencing outcomes of the treatment of positional plagiocephaly in infants: a 7-year experience [J]. J Neurosurg Pediatr, 2017, 19(3): 273-281.
28	Branch LG, Kesty K, Krebs E, et al. Deformational plagiocephaly and craniosynostosis: trends in diagnosis and treatment after the "back to sleep" campaign [J]. J Craniofac Surg, 2015, 26(1): 147-150.
29	Purnell CA, Benz AW, Gosain AK. Assessment of head shape by craniofacial teams: structuring practice parameters to optimize efficiency [J]. J Craniofac Surg, 2015, 26(6): 1808-1811.
30	Wittmeier K, Mulder K. Time to revisit tummy time: a commentary on plagiocephaly and development [J]. Paediatr Child Health, 2017, 22(3): 159-161.
31	Nichter S. A clinical algorithm for early identification and intervention of cervical muscular torticollis [J]. Clin Pediatr (Phila), 2016, 55(6): 532-536.
32	Kim HJ, Ahn HS, Yim SY. Effectiveness of surgical treatment for neglected congenital muscular torticollis: a systematic review and meta-analysis [J]. Plast Reconstr Surg, 2015, 136(1): 67e-77e.
33	Fu KJ, Teichgraeber JF, Greives MR. Botulinum toxin use in pediatric plastic surgery [J]. Ann Plast Surg, 2016, 77(5): 577-582.
34	Gündüz A, Korkmaz B, Kiziltan ME. Effective treatment of congenital muscular torticollis using botulinum toxin [J]. J Craniofac Surg, 2014, 25(5): 1935.
35	He L, Yan X, Li J, et al. Comparison of 2 Dosages of Stretching Treatment in Infants with Congenital Muscular Torticollis: A Randomized Trial [J]. Am J Phys Med Rehabil, 2017, 96(5): 333-340.
36	Lee I. The effect of postural control intervention for congenital muscular torticollis: a randomized controlled trial [J]. Clin Rehabil, 2015, 29(8): 795-802.
37	Genna CW. Breastfeeding infants with congenital torticollis [J]. J Hum Lact, 2015, 31(2): 216-220.
38	Aarnivala H, Vuollo V, Harila V, et al. Preventing deformational plagiocephaly through parent guidance: a randomized, controlled trial [J]. Eur J Pediatr, 2015, 174(9): 1197-1208.
39	Kuo AA, Tritasavit S, Jr GJ. Congenital muscular torticollis and positional plagiocephaly [J]. Pediatr Rev, 2014, 35(2): 79-87.
40	胥文娟，肖红，邢家铭, 等. 小儿先天性肌性斜颈的推拿治疗研究进展 [J]. 中医儿科杂志, 2017, 13(2): 88-91.
41	Kim HJ, Ahn HS, Yim SY. Effectiveness of surgical treatment for neglected congenital muscular torticollis: a systematic review and meta-analysis [J]. Plast Reconstr Surg, 2015, 136(1): 67e-77e.
42	Oleszek JL, Chang N, Apkon SD, et al. Botulinum toxin type a in the treatment of children with congenital muscular torticollis [J]. Am J Phys Med Rehabil, 2005, 84(10): 813-816.
43	Collins A, Jankovic J. Botulinum toxin injection for congenital muscular torticollis presenting in children and adults [J]. Neurology, 2006, 67(6): 1083-1085.
44	Chen HX, Tang SP, Gao FT, et al. Fibrosis, adipogenesis, and muscle atrophy in congenital muscular torticollis [J]. Medicine (Baltimore), 2014, 93(23): e138.
45	Lee K, Chung E, Lee BH. A comparison of outcomes of asymmetry in infants with congenital muscular torticollis according to age upon starting treatment [J]. J Phys Ther Sci, 2017, 29(3): 543-547.
46	Carenzio G, Carlisi E, Morani I, et al. Early rehabilitation treatment in newborns with congenital muscular torticollis [J]. Eur J Phys Rehabil Med, 2015, 51(5): 539-545.

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Physical therapy examination and intervention of congenital muscular torticollis in the ICF-CY framework

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Physical therapy examination and intervention of congenital muscular torticollis in the ICF-CY framework