采用颈前小切口切断胸锁乳突肌43例剖析.docVIP

采用颈前小切口切断胸锁乳突肌43例剖析 　　摘要：目的评价小切口（0.8~1 cm）切断胸锁乳突肌以治疗先天性肌性斜颈方法。方法对43例患者采取颈前下缘0.8~1 cm长手术切口入路切断胸锁乳突肌胸骨头及锁骨头，从手术难度、手术时间、手术出血量、机体创伤大小方面，评价此手术方法。结果小切口能够完成对纤维化的胸锁乳突肌切断，手术时间平均18分钟，手术出血少，颈部伤口小，瘢痕不明显，无并发症发生。结论小切口治疗先天性肌性斜颈创伤小、效果满意，是一种值得参考的手术方法。 　　关键词：小切口；胸锁乳突肌；先天性肌性斜颈 　　Analysis of the Clinical Effect of Sternocleidomastoid Muscle in 43 Cases of Small Incision to Cut off the Anterior Cervical Incision 　　ZHOU Hai,YUE Yi-gang,SHAO Jia-song,ZHANG Min,HUA Ming-chun,LI Xin-shan 　　(Department of Plastic Surgery,Affiliated Hospital of Guilin Medical College,Guilin 541001,Guangxi,China) 　　Abstract：ObjectiveTo evaluate the method of making a small incision (0.8 ~ 1 cm) cut off sternocleidomastoid for treatment of congenital muscular torticollis. Methods 43 patients had been taken 0.8 ~ 1 cm long surgical incisions at throat lower edge as the road cutting off sternocleidomastoid breast bones and clavicle head. We evaluate the surgical method according to the difficulty, operation time, bleeding and the bodys surgical trauma. ResultsSmall incision can completely cut off the fibrosis of the sternocleidomastoid with average 18 minutes operation, less bleeding, a small wound, not obviously scar and no complication. ConclusionSmall incision for treatment of congenital muscular torticollis make small trauma. The result is satisfactory. It is worth of reference surgical method. 　　Key words：Small incision;Sternocleidomastoid;Congenital muscular torticollis 　　先天性肌性斜颈是婴幼儿常见病。它多由于胸锁乳突肌纤维化、挛缩[1]，使头、颈向患侧偏斜，严重者可导致患侧颜面萎缩。传统手术方法是在患侧颈下缘做3~4 cm长手术切口[2-3]，充分显露胸锁乳突肌胸骨头及锁骨头后再予切断。我科于 2011 年 1 月开始采用颈前小切口（皮肤切开0.8~1 cm）入路，切断胸锁乳突肌的胸骨头及锁骨头，效果良好。 　　1资料与方法 　　1.1一般资料 本组43例，男25例，女18例，年龄10月~3岁，平均年龄1岁。 　　1.2方法 　　1.2.1麻醉方法 气管插管全麻。 　　1.2.2手术方法 患者取仰卧，患侧肩垫高，头后仰，使患侧胸锁乳突肌绷紧。在锁骨内侧上方1.5 cm处沿颈皮纹做0.8~1 cm横切口，切开皮肤、颈阔肌。向内侧牵引伤口，显露胸骨头，用蚊式止血钳分束分次将纤维化肌肉挑出伤口外，电刀切断；再向另外侧牵开伤口，同样方法切断锁骨头。仔细探查、松解胸锁乳突肌周围挛缩索带。以使颏部能转到患侧肩峰。止血后伤口内放胶片引流。皮肤伤口采用皮内缝合1～2针或使用医用生物胶粘合。 　　2.3术后处理 24 h后拔引流胶片。术后5 d出院。颈托固定6个月。 　　2.4疗效标准评定 优：颈部无明显畸形，无残留包块，无面