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1、课程名称小儿外科学教研室小儿外科授课题目先天性肌性斜颈学时数1（40分钟）教师姓名刘星职 称副教授授课日期2015.10.30授课年级2011级授课专业七年制儿科学生人数149教材及参考书（含教材名称、版次、主编、出版社）：1.小儿外科学第五版 蔡威 孙宁 魏光辉主编 人民卫生出版社2.实用小儿骨科学（第二版）吉士俊、潘少川、王继孟主编，山东科技出版社3.坎贝尔骨科手术学（中译本）【美】S.Terry Canale，James H. Beaty主编，王岩主译，人民军医出版社教学目的及要求(掌握、熟悉、了解的具体内容等)：1.掌握先天性肌性斜颈的治疗原则；2.熟悉先天性肌性斜颈的临床表现、诊断、
2、鉴别诊断；3.了解先天性肌性斜颈的病因及病理特点。教学重点：先天性肌性斜颈的临床表现、诊断、鉴别诊断和治疗原则。教学难点：先天性肌性斜颈的诊断和鉴别诊断。教学手段（含特殊教具与器材）：采用POWERPOINT格式外语要求（根据专本七年制不同层次每个病种提出5-10个中英文关键词） 先天性肌性斜颈（congenital muscular torticollis)、婴儿良性阵发性斜颈（benign paraxysmal torticolis, BPT）、寰枢关节旋转移位（atlantoaxial rotary displacement）、（neck collar traction）颈托牵引、锁骨骨
3、折（fracture of clavicle） 、挛缩（contracture）学习指导（含思考题和课外阅读建议）思考题：1、如何诊断先天性肌性斜颈，需与哪些疾病鉴别？2、先天性肌性斜颈的治疗原则是什么？2个月发现并确认的患儿应该如何处理？阅读建议：结合讲课内容学习参考教材。备注（1.关于相同内容重复教学的修改情况等。2.执行教案后的自我分析与评价） 教学工作中围绕教学大纲，积极认真备课，结合临床实际操作，重点突出，提供参考文献让同学课后查阅，深受同学们好评。重庆医科大学儿科学院理论课教案（续页）主要教学内容及时间分配教学方法（含互动设计）备注【概述】（5分钟）1.通过先天性肌性斜颈患儿的照片
4、让学生直观了解该病的临床特点（头颈偏斜、面容不对称、患侧胸锁乳突肌紧张）；2.简要介绍该病发病情况。3.应用解剖图片，复习胸锁乳突肌解剖，有利于对本病的深刻理解。【胚胎发育及病因】（5分钟）简要介绍常见的几种病因学说和观点。【病理改变】（3分钟）1.通过病理图片介绍先天性肌性斜颈的病理改变。2.结合电镜表现分析非手术疗法的依据？【临床表现】（5分钟）1.重点讲解新生儿包块的特点及变化，结合患儿图片加深印象；2.结合患儿图片总结患儿体征，根据胸锁乳突肌解剖分析头颈活动受限情况。【诊断】（5分钟）重点讲解先天性肌性斜颈的诊断要点；通过超声图像讲解超声在本病中诊断价值。【鉴别诊断】（10分钟）举例讲
5、解常见的鉴别诊断疾病。【治疗】（5分钟）结合图片介绍非手术及手术治疗方法、原则及术后处理，强调术后处理的重要性。【思考题】（2分钟）与学生互动，通过思考题的形式回顾本堂课的重点知识。讲 稿 内 容Congenital Muscular Torticollis (CMT)一、 Introduction1. Congenital muscular torticollis or congenital wry neck is the most common cause of torticollis in the infant and young child .2. The deformity is c
6、aused by contractureof the sternocleidomastoid muscle， with the head tilted toward the involved side and the chin rotated toward the opposite shoulder. 3.Mobidity is about 3-5.4.80% of cases occur on the right side .5. If the deformity is progressive，skull and face deformities can develop. 6. up to
7、20% of cases have developmental hip dysplasia . 二、Etiology（一）Direct reason：sternocleidomastoid muscle fibrosis and contracture（二）Why? The exact cause is not known.（三）Several theories1. Birth trauma（1）Hemorrhage（2）Prolong labour2. Insufficient blood supply 3. Congenital malformation 4. A compartment
8、syndrome of the sternocleidomastoid muscle occurs5. Genetic predisposition三 、Pathology（一）1 year old1.A mass or “tumor” may be palpable in the neck.2.Histopathology （1）like fibroma（2）edema、degeneration of muscle fibers and muscle fibrosis, without hemosiderosis.（3）myoblasts and fibroblasts in sternoc
9、leidomastoid tumors.（二）1 year old1. Lump gradually regresses.2. fibrosis and contracture of the sternocleidomastoid muscle.四、Clinical manifestation 1 year old1.Lump is a nontender，soft enlargement beneath the skin， and is located within the sternocleidomastoid muscle belly. 2. Tumor reaches its maxi
10、mum size within the first 4 weeks of life then gradually regresses. After 4 to 6 months of life the contracture and the torticollis are the only clinical findings.3. If the deformity is progressive， skull and face deformities can develop（二） 1 year old1.The deformity is progressive: the head tilted t
11、oward the involved side and the chin rotated toward the opposite shoulder. 2. Facial deformity or a limitation of motion， and further facial flattening and further cosmetic deterioration .3.The level of the eyes and ears becomes unequal and can result in considerable cosmetic deformity. 4.Cervical s
12、pine deformity五、 Diagnosis（一）Torticollis（二）Sternocleidomastoid muscle lesions 1.Lump 2.The contracture and a limitation of motion 3.Ultrasonography4. Histopathology（三）Breech birth（四）Rule out others六、Differential diagnosis1.Fracture of clavicle at the time of delivery2.Cervical spine deformity 3. Atl
13、antoaxial rotary displacement4. Ocular torticollis5.Benign paraxysmal torticollis, BPT6. soft tissue infection of the neck 7.Tuberculosis or tumor8. Spasmodic torticollis9.Cerebral palsy10.Habitual torticollis11.Televisionary torticollis 七、Treatment（一）、 1 year old Conservative: a regimen of stretchi
14、ng exercises and room modifications （二）、Surgical release1. The best time: 12 years old2.Methods: a unipolar release at the sternoclavicular or mastoid pole; bipolar release; middle third transection; complete resection; a Z-plasty of the sternal attachment （三）、Postoperative protocol Cast or orthosis
15、 immobilization.Neck collar traction.八、 Complications（一）、Infection of incisions（二）、Injury of spinal accessory nerve（三）、Injury of pleura（四）、Injury of blood vessel（五）、Postoperative relapse理论大课讲授形式参考文献：1.小儿外科学第五版 蔡威 孙宁 魏光辉主编 人民卫生出版社2.实用小儿骨科学（第二版）吉士俊、潘少川、王继孟主编，山东科技出版社3.坎贝尔骨科手术学（中译本）【美】S.Terry Canale，James H. Beaty主编，王岩主译，人民军医出版社
