摘要
目的探讨内窥镜下离断胸锁乳突肌治疗肌性斜颈的效果。方法在右侧腋窝的皮纹线内置入5mmTrocar,手持镜头将颈阔肌下的脂肪层组织与胸锁乳突肌下端的胸骨头和锁骨头表面的肌膜相分离,这样显露了肌肉同时形成了空间,将CO2气体冲入加压至6mmHg。颈中和颈下横纹内分别导入3mmTrocar和器械。用电凝或电切逐渐将所有胸锁乳突肌纤维束横断,同时松解胸锁乳突肌周围的纤维组织。结果采用以上方法治疗5例右肌性斜颈患儿,均在内窥镜下完成手术,手术时间45～135min,失血量极少,均少于1ml,1例患儿颈部切口处有轻微电灼伤,2周后自愈。术后患儿即可以进行颈部舒展活动训练,术后次日出院,随访3个月～1年,斜颈均矫正,颈部3mmTrocar切口和腋窝内5mm切口瘢痕不明显,颈部皮肤弹性好,无随表情异常活动现象。结论内镜下切断胸锁乳突肌治疗肌性斜颈具有微创、痛苦小、恢复快、效果好的优点,瘢痕不明显,美观而且不损伤颈阔肌,对表情活动无影响,是值得推广的治疗方法之一。
Objective Surgical amputation of the sternocleidomastoid muscle was recommended for the children with muscular torticollis, if they fail respond to physical therapy. However, the conventional open surgical techniques left noticeable scars. Herein we present our experience with endoscopic surgery for the treatment of congenital muscular torticollis. Methods From July 2001 to June 2003, 5 patients with congenital muscular torticollis were treated in our department. There were 3 females and two male. The mean age at surgery was 3.4 years ( range, 2～4 years). Through three ports ( one 5mm port at the axilla for endoscope and two 3 mm ports for the instruments which were inserted along the lateral border of the sternocleidomastoid muscle on the involved side), the inferior portion of the muscle was dissected and divided with electro cautery. To prevent recurrence, the external investing fascia within which the sternocleidomastoidmuscle resides was also adequately divided. Results complete muscular release was successfully performed in all 5 patients without obvious complication. Duration of the operation ranged from 45 to 135 minutes. We observed good results in 6 to 30 months follow-up in the 5 patients. Cosmetic result was excellent in all patients. Conclusions Using sternocleidomastoid muscle amputation to treat the muscular torticollis with endoscope approach has lot of advantages,such as microtrauma, less pain,quick recovery,excellent efficacy,especially in that the cervical part incision small(only 3mm width) unnoticeable scar.Apperance beautiful,platysma untrauma,facial expression is no influence.So that,we consider that the operation have popularization value in clinical treatment.
出处
《临床小儿外科杂志》
CAS
2004年第2期81-84,共4页
Journal of Clinical Pediatric Surgery
关键词
斜颈/外科学
乳突
内窥镜检查
Biliary Tract Diseases/DI
Biliary Tract Diseases/TH
