婴儿肌肉性斜颈症

<span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;"><span style="font-family:微软雅黑;">婴儿肌肉性斜颈症是指先天或后天颈部活动受限，可发现婴儿头部倾向患侧及下巴转向对侧，患侧的颈部可能摸到肿块。颈部转动受限制，头歪一边，下巴朝向另一边，其它症状如患侧脸部变小、下倾、眼及嘴角下垂、患侧眼睛变小，患侧耳朵相对前移及头盖骨不对称(患侧前额骨与对侧枕骨变得较扁平)。先天性肌肉性斜颈常发现于6-8周大的婴儿，大部份是因胸锁乳突肌之缩短造成，其颈部可能有一硬块于胸锁乳突肌中，肿块被纤维组织取代，若不处理会变成颈部转动受限。续发性的问题有姿势性斜视、下颈部或上背部之脊柱侧弯。</span><br /> <br /> <span style="font-family:微软雅黑;">引起原因：</span><br /> <span style="font-family:微软雅黑;">真正原因至今不明，以胸锁乳突肌纤维化最常见。其它可能原因如下：</span><br /> <span style="font-family:微软雅黑;">一、先天性骨骼畸形。</span><br /> <span style="font-family:微软雅黑;">二、斜视。</span><br /> <span style="font-family:微软雅黑;">三、遗传。</span><br /> <span style="font-family:微软雅黑;">四、子宫内胎位不正，而造成臀位产。</span><br /> <span style="font-family:微软雅黑;">五、子宫内或生产中腔室症候群(compartment　syndrome)。</span><br /> <span style="font-family:微软雅黑;">六、锁乳突肌缺血、纤维化。</span><br /> <br /> <br /> <span style="font-family:微软雅黑;">超音波检查分类：</span><br /> <span style="font-family:微软雅黑;">第一类：胸锁乳突肌假性肿块。</span><br /> <span style="font-family:微软雅黑;">第二类：弥漫纤维化但有正常的肌肉 。</span><br /> <span style="font-family:微软雅黑;">第三类：弥漫纤维化但无正常的肌肉。</span><br /> <span style="font-family:微软雅黑;">第四类：索状纤维化。</span><br /> <br /> <br /> <span style="font-family:微软雅黑;">康复治疗：</span><br /> <span style="font-family:微软雅黑;">先天性斜颈治疗以康复治疗为主，如果出生三个月内就开始接受复健治疗，其治愈率高达92﹪。它的主要目的是使病童在4个月内大时，颈部的被动性运动能够完成不受紧缩胸锁乳突肌的影响。康复治疗包刮：</span><br /> <span style="font-family:微软雅黑;">一、按摩。</span><br /> <span style="font-family:微软雅黑;">二、热敷：包括超音波疗法。</span><br /> <span style="font-family:微软雅黑;">三、摆置病童：平时尽量将头保持在正中，睡觉亦是。若病童右耳偏向右肩，脸转向左边，则其患侧为「右侧」胸锁乳突肌。反之亦然。</span><br /> <span style="font-family:微软雅黑;">(一)婴儿床的摆置：患侧朝外，玩具挂于患侧，让病童往患侧看。</span><br /> <span style="font-family:微软雅黑;">(二)喂奶时由患侧喂食。</span><br /> <span style="font-family:微软雅黑;">(三)可用毛巾枕头来固定病童头部，必要时可戴颈圈，但需注意呼吸道的畅通。</span><br /> <span style="font-family:微软雅黑;">(四)母亲睡于病童患侧。</span><br /> <span style="font-family:微软雅黑;">(五)抱病童时将病童头转向患侧；俯卧时转向患侧，脸部朝上。</span><br /> <br /> <span style="font-family:微软雅黑;">四、被动性伸展运动：</span><br /> <span style="font-family:微软雅黑;">每个动作做到底维持10秒，可渐渐增加次数。</span><br /> <span style="font-family:微软雅黑;">(一)头前屈。</span><br /> <span style="font-family:微软雅黑;">(二)头后仰。</span><br /> <span style="font-family:微软雅黑;">(三)好耳贴好肩</span><br /> <span style="font-family:微软雅黑;">(四)头转向患侧以下巴碰患肩</span><br /> <span style="font-family:微软雅黑;">五、诱发主动的动作：逗病童玩，尽量让病童头部转向患侧。</span><br /> <span style="font-family:微软雅黑;">六、使用颈圈：</span><br /> <span style="font-family:微软雅黑;">(一)材料：采软硬适中，两片式。</span><br /> <span style="font-family:微软雅黑;">(二)使用时间：约3-4个月左右。</span><br /> <span style="font-family:微软雅黑;">(三)使用时机：除了吃奶、睡觉、洗澡外都要使用。</span><br /> <span style="font-family:微软雅黑;">(四)停止时机：视情况告知。</span><br /> <br /> <span style="font-family:微软雅黑;">总之，在婴幼儿时期需加强患侧颈肌肉伸展性，需定期回诊，评估康复效果。</span><br /> <br /> <span style="font-family:微软雅黑;">预后：</span><br /> <span style="font-family:微软雅黑;">约8-9成的病患经康复治疗后会有进步，约有1 成需手术治疗。</span><br /> <br /> <span style="font-family:微软雅黑;">手术治疗：</span><br /> <span style="font-family:微软雅黑;">一、手术对象：</span><br /> <span style="font-family:微软雅黑;">(一)超音波检查分类第三及第四型之病童。</span><br /> <span style="font-family:微软雅黑;">(二)康复治疗6个月无效者。</span><br /> <span style="font-family:微软雅黑;">(三)一岁以上病童颈部旋转少于健侧30度且有大小脸现象。</span><br /> <span style="font-family:微软雅黑;">二、手术方法：常用是将紧缩胸锁乳突肌远程的锁骨肌腱头及胸骨肌腱头部分或完全切断，加上颈筋膜切开术，使头颈部的运动能回复到正常位置。</span><br /> <span style="font-family:微软雅黑;">三、术后照顾︰</span><br /> <span style="font-family:微软雅黑;">(一)术后第一天伤口会用纱布加压止血，注意纱布是否渗湿并更换保持干净。</span><br /> <span style="font-family:微软雅黑;">(二)术后第二天拆开伤口敷料，观察伤口是否有红肿热痛，并保持伤口干燥清洁。</span><br /> <span style="font-family:微软雅黑;">(三)术后两周评估恢复状况，并安排物理治疗，以达到良好治疗。</span><br /> <br /> <span style="font-family:微软雅黑;">厦门长庚医院康复科~关心您~</span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span><br /> </span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span style="font-family:微软雅黑;"></span></span><span 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