Clinical Analysis Of Early Recognition Of Congenital Muscular Torticollis By Surface Electromyography

Objective: To explore the diagnostic value of surface electromyography in children with congenital muscular torticollis who had negative results in bilateral sternocleidomastoid muscles examined by color Doppler ultrasound.Methods:This study enrolls 100 children with congenital muscular torticollis and 48 healthy infants who first visited in the Children's Hospital Affiliated to Chongqing Medical University from September 2017 to September 2018 and were negative for color Doppler ultrasound.The EMG data of bilateral sternocleidomastoid muscles were collected under the median resting and active state of the infant's sitting position,and the corresponding RMS values were calculated.The active state includes four positions: left-turn head position,right-turn head position,front-down head position and back-up head position.Then,the root mean square values are checked by SPSS(17.0)software,and the corresponding ROC curves are drawn.Results:(1)The RMS data of bilateral sternocleidomastoid muscles in five postures of normal infants in the same age control group had statistical significance except for the front-down head position(P <0.05).The AUC value of bilateral sternocleidomastoid muscle in resting state and symmetrical active state was less than 0.5.It is suggested that there is no significant difference in the curtain potential of surface electromyography between bilateral sternocleidomastoid muscles of normal infants in resting and symmetrical activity state.While the AUC value of unilateral sternocleidomastoid muscle in active state was more than 0.9.It is suggested that there were significant differences in the curtain potential of surface electromyography between bilateral sternocleidomastoid muscles of normal infants in unilateral sternocleidomastoid muscle in activity state.(2)Compared CMT group with control group,the RMS mean value of sternocleidomastoid muscle on affected side in CMT group was lower than the RMS mean value of bilateral sternocleidomastoid muscle in control group in resting and symmetrical activity state.And the RMS mean value of sternocleidomastoid muscle on healthy side in CMT group was no significant difference between the RMS mean value of bilateral sternocleidomastoid muscle in control group in homologous state.It is suggested that the curtain potential of sternocleidomastoid muscle on healthy side in CMT group had no significant differences from that on bilateral sternocleidomastoid muscle in control group.But the curtain potential of sternocleidomastoid muscle on affected side in CMT group was lower than that on bilateral sternocleidomastoid muscle in control group.(3)Comparing the sternocleidomastoid muscle of the affected side with the sternocleidomastoid muscle of the contralateral side in five positions of CMT group,the difference was statistically significant(P<0.05).The mean square root value of sternocleidomastoid muscle on the affected side was less than that of the contralateral sternocleidomastoid muscle except for the position of left turning head,suggesting that there was asymmetry of bilateral sternocleidomastoid motor curtain potential in children with congenital muscular torticollis who were negative by color Doppler ultrasonography.And the average area under ROC curve of the four groups was 0.741,suggesting that surface electromyography has certain diagnostic significance for children with congenital muscular torticollis whose color Doppler ultrasound is negative.Conclusion: The root mean square value of surface electromyogram of the affected side and the contralateral side of congenital muscular torticollis children with negative color Doppler ultrasonography is significantly different,and mean square root value of sternocleidomastoid muscle on the contralateral side is higher than that on the affected side.Combined with the area under ROC curve,it is suggested that surface electromyography is sensitive to detect the function of sternocleidomastoid muscle,and can be used as an auxiliary index for clinical diagnosis of congenital muscular torticollis in children.