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Abstract：
BACKGROUND: This study aimed to investigate the clinical efficacy of minimally invasive endoscopic treatment of children with congenital muscular torticollis (CMT).
METHODS: In total, 72 children (41 male, 31 female) with CMT who underwent endoscopic surgery at the Department of Orthopedics, Xi\'an Children\'s Hospital, between January 2021 and January 2023 were included. Their mean age was 54 ± 36.1 (range, 12-141) months. Of these, 29 (40.3%) cases involved the left side while 43 (59.7%) involved the right side. Preoperative preparation involved precise body surface markings of the sternocleidomastoid muscle(SCM), clavicle, and important nerve and blood vessels, followed by the establishment of surgical channels through passive separation techniques. An arthroscope and a low-temperature plasma knife were utilized for accurate localization and surgical release of the clavicular and sternal heads of the SCM. The duration of surgery, blood loss, postoperative hospital stay, neck range of motion measurements, and any intraoperative or postoperative complications were analyzed using the rank sum test. Cervical and thoracic braces were applied for three months postoperatively, with follow-up assessments conducted using Cheng\'s scoring system.
RESULTS: All patients successfully underwent endoscopic surgery, without the need for conversion to open surgery. No intra- or postoperative complications were observed. The average surgical duration was 56.4 ± 15.7 min, with minimal intraoperative bleeding (1-5 mL) and no need for blood transfusion. The mean postoperative hospital stay was 2.7 ± 0.8 days. Over a mean follow-up period of 22.2 ± 5.5 (range, 14-32) months, significant improvements were observed in neck rotation (from 20.2° [17.7° to 25°] to only 3.6° [2° to 6.7°]) and lateral flexion (from 19° [17° to 22.6°] to only 3° [2° to 7.8°]) restrictions (p < 0.05). According to Cheng\'s scoring system, 70 (97.2%) patients achieved excellent or good clinical outcomes, while 2 (2.8%) had average outcomes. The torticollis deformity was corrected during the follow-up period, and all surgical incisions healed without noticeable scarring.
CONCLUSIONS: Endoscopic release is a safe, effective, and minimally invasive treatment option for CMT in children.
METHODS: In total, 72 children (41 male, 31 female) with CMT who underwent endoscopic surgery at the Department of Orthopedics, Xi\'an Children\'s Hospital, between January 2021 and January 2023 were included. Their mean age was 54 ± 36.1 (range, 12-141) months. Of these, 29 (40.3%) cases involved the left side while 43 (59.7%) involved the right side. Preoperative preparation involved precise body surface markings of the sternocleidomastoid muscle(SCM), clavicle, and important nerve and blood vessels, followed by the establishment of surgical channels through passive separation techniques. An arthroscope and a low-temperature plasma knife were utilized for accurate localization and surgical release of the clavicular and sternal heads of the SCM. The duration of surgery, blood loss, postoperative hospital stay, neck range of motion measurements, and any intraoperative or postoperative complications were analyzed using the rank sum test. Cervical and thoracic braces were applied for three months postoperatively, with follow-up assessments conducted using Cheng\'s scoring system.
RESULTS: All patients successfully underwent endoscopic surgery, without the need for conversion to open surgery. No intra- or postoperative complications were observed. The average surgical duration was 56.4 ± 15.7 min, with minimal intraoperative bleeding (1-5 mL) and no need for blood transfusion. The mean postoperative hospital stay was 2.7 ± 0.8 days. Over a mean follow-up period of 22.2 ± 5.5 (range, 14-32) months, significant improvements were observed in neck rotation (from 20.2° [17.7° to 25°] to only 3.6° [2° to 6.7°]) and lateral flexion (from 19° [17° to 22.6°] to only 3° [2° to 7.8°]) restrictions (p < 0.05). According to Cheng\'s scoring system, 70 (97.2%) patients achieved excellent or good clinical outcomes, while 2 (2.8%) had average outcomes. The torticollis deformity was corrected during the follow-up period, and all surgical incisions healed without noticeable scarring.
CONCLUSIONS: Endoscopic release is a safe, effective, and minimally invasive treatment option for CMT in children.
摘要：
背景：本研究旨在探讨微创内镜治疗儿童先天性肌性斜颈的临床疗效。
方法：总共，72名儿童（41名男性，31名女性）在骨科接受内窥镜手术的CMT，西安市儿童医院,包括2021年1月至2023年1月。他们的平均年龄为54±36.1(范围，12-141）个月。其中,左侧有29例（40.3％），右侧有43例（59.7％）。术前准备包括胸锁乳突肌（SCM）的精确体表标记，锁骨,重要的神经和血管，其次是通过被动分离技术建立手术通道。使用关节镜和低温等离子刀对SCM的锁骨和胸骨头进行精确定位和手术释放。手术的持续时间,失血,术后住院时间,颈部运动范围测量，术中或术后并发症均采用秩和检验进行分析.术后应用颈、胸支架三个月，使用Cheng的评分系统进行后续评估。
结果：所有患者均成功接受内镜手术，不需要转换为开放手术。未观察到术中或术后并发症。平均手术时间为56.4±15.7min,术中出血最少（1-5mL），无需输血。术后平均住院时间为2.7±0.8天。在平均22.2±5.5的随访期内(范围，14-32）个月，在颈部旋转(从20.2°[17.7°至25°]到仅3.6°[2°至6.7°])和侧向屈曲(从19°[17°至22.6°]到仅3°[2°至7.8°])限制方面观察到显著改善(p<0.05).根据程的评分系统，70例（97.2%）患者取得了优异或良好的临床结果，2例(2.8%)有平均结局。在随访期间矫正了斜颈畸形,所有手术切口均愈合，无明显疤痕。
结论：内镜松解术是安全的，有效,以及儿童CMT的微创治疗选择。
方法：总共，72名儿童（41名男性，31名女性）在骨科接受内窥镜手术的CMT，西安市儿童医院,包括2021年1月至2023年1月。他们的平均年龄为54±36.1(范围，12-141）个月。其中,左侧有29例（40.3％），右侧有43例（59.7％）。术前准备包括胸锁乳突肌（SCM）的精确体表标记，锁骨,重要的神经和血管，其次是通过被动分离技术建立手术通道。使用关节镜和低温等离子刀对SCM的锁骨和胸骨头进行精确定位和手术释放。手术的持续时间,失血,术后住院时间,颈部运动范围测量，术中或术后并发症均采用秩和检验进行分析.术后应用颈、胸支架三个月，使用Cheng的评分系统进行后续评估。
结果：所有患者均成功接受内镜手术，不需要转换为开放手术。未观察到术中或术后并发症。平均手术时间为56.4±15.7min,术中出血最少（1-5mL），无需输血。术后平均住院时间为2.7±0.8天。在平均22.2±5.5的随访期内(范围，14-32）个月，在颈部旋转(从20.2°[17.7°至25°]到仅3.6°[2°至6.7°])和侧向屈曲(从19°[17°至22.6°]到仅3°[2°至7.8°])限制方面观察到显著改善(p<0.05).根据程的评分系统，70例（97.2%）患者取得了优异或良好的临床结果，2例(2.8%)有平均结局。在随访期间矫正了斜颈畸形,所有手术切口均愈合，无明显疤痕。
结论：内镜松解术是安全的，有效,以及儿童CMT的微创治疗选择。
