The Clinical Outcome Of Manual Myotomy During Manual Stretching Infants With Congenital Muscular Torticollis

Objective: The aim of current study is to compare the clinic outcome between cases with and without manual myotomy during stretching treatment for the infants with congenital muscular torticollis(CMT)and to analyze the influencing factors which are related to clinical phenomenon of manual myotomy.Methods: Ninety seven infants with congenital muscular torticollis who underwent manual stretching at Torticollis Clinic in Shenzhen Children's Hospital from July 2005 to August 2017 were studied by using retrospective cohort design.There were 48 cases with snapping regarded as give-way group,i.e.GW group and 49 cases without snapping regarded as non-give way group,i.e.GW group during the treatment of manual stretching.All cases were followed-up either by telephone queries or by assessing final overall outcome in out-patient torticollis clinic by physical examination.Mann-whitney rank-sum test was used for the difference between ears and eyes,between ears and nose,between eyes and mouth,between ears and mouth,and between the head and head.The contracture muscle bundles,head tilt,subjective evaluation and cheng-tang total score of the two groups of children were tested by mann-whitney rank sum test(?=0.05).Results: There was no significant difference between the two groups in measurement of distance between ear-eye,ear-nose,eye-mouth,ear-mouth,half-head circumference and half-head top between GW group and non-GW group before and after treatment(P> 0.05).Mann-Whitney rank sum test was used to compare the difference of muscle contracture,head tilte,subjective evaluation and total score of Cheng-tang in the two groups and no significant difference was found(P>0.05).The no condition logistic regression analysis was used to detect risk factor of MM under the condition of MM regarded as dependent variable and interval time,treatment of frequency and birth weight regarded as independent variable.The results showed that the age at diagnosis,the interval time of treatment and treatment of frequency were significant between the two groups(p<0.05).Conclusion: There is no significant difference in the clinical efficacy in the two groups.The results implies that therapist would not achieve the manual myotomy when perform the stretching program for the treatment of CMT.Using manual stretching for the treatment of infants with CMT,therapist and doctors must be keep in mind that manual myotomy could be happen and pay attention to take care of the infant after the phenomenon.If the infant with CMT has been diagnosed at earlier age,interval time between the diagnosis and first treatment is short and treatment frequency is higher,the treatment of stretching SCM is higher possibility to happen manual myotomy.