선천성 근성사경의 외과적 치료

Abstract

Congenital muscular torticollis has been recognized for centuries, but its pathogenesis and treatment remains controversial. The cosmetic disability causes most parents to seek medical care for their child, but late sequelae such as facial asymmetry, scoliosis, and disturbed vision can occur. Operative treatment of congenital muscular torticollis is generally considered to be indicated if head tilting persists beyond the age of twelve months despite conservative therapy. Since 1991, fifteen patients, between 4 and 26 years of age, had been managed with biterminal open release and sternocleidomastoid muscle lengthening method. With a follow-up period of at least 8 months (average 24 months), improvement or resolution of facial asymmetry was not acvhieved, but showed good to fair cosmetic or functional outcome with no case of recurrence. Though the surgical procedure is technically more complicated than inferior or superior tenotomy alone, the author recommend that biterminal release and lengthening, with at least 6 months of physiotherapy, be performed before the age of 5 years for patients who do not respond to nonoperative conservative treatment.

본 교실에서 선천성사경 15례를 수술적 방법으로 치료한 결과 다음과 같은 결론을 얻었다. 1. 중등도 이상의 경우 흉쇄유돌근 기시부와 부착부를 절단하고 근육을 연장하는 양극해리 및 근연장법이 효과적이다. 2. 7세 미만의 소아에서는 사경의 정도가 심하지 않아 술후 더 만족스런 결과를 보였으며 성인의 경우 완전한 교정이 어려웠다. 3. 수술의 적기는 물리치료와 목의 고정에 협조적인 5세 전후이다. 4. 술후 최소 6개월간의 물리치료와 목의 고정이 요구된다.