Basic And Clinical Research On The Treatment Of Torticollis In Children By Manual Therapy Combined With Blood Circulation And Tendon-activating Ointmen

Background:Children torticollis is an abnormal position of head and neck.There are more than 80 different potential causes of torticollis,and the incidence of torticollis in newborns can be as high as 16%.There is difficulty in diagnosis,treatment and evaluation of torticollis in children,because of the complex etiology of torticollis,the difficulty in expressing the condition of children and the lack of coordination in diagnosis and treatment.Based on several years of clinical data in the early stage,the study summarized the spectrum data of diseases and the treatment plan of torticollis,and explored a new evaluation method of torticollis.Objective:1 To study the types and incidence of torticollis disease spectrum in children,compare the composition differences of disease spectrum in different age groups,summarize the data of torticollis visiting departments,revise the flow chart of torticollis diagnosis,provide an important reference for the diagnosis of torticollis,and demonstrate that the diagnostic treatment of postural torticollis is the core of the diagnosis of torticollis with torticollis as the only clinical manifestation.2 To compare the clinical efficacy of massage combined with Huoxue Roujin ointment and physiotherapy in the treatment of postural torticollis,and to explore an efficient and standardized diagnostic treatment plan for postural torticollis.3 To compare the clinical efficacy of massage combined with Huoxue Roujin ointment and massage in the treatment of congenital muscular torticollis(CMT),and to verify the clinical efficacy of in-hospital contractors.4 To provide a reliable new method for CMT,study the reliability of sternocleidomastoid extensibility(SCME)measurement method,evaluate the correlation between SCME and CMT "gold index"(cervical passive range,PROM),and preliminarily apply this method to evaluate the effect of different stretching methods on SCME.Methods:1A single-center retrospective study was used to collect the outpatient medical records of torticollis or massage clinics from 2017 to 2021 in Capital Medical University,National Children’s Medical Center,screen the medical record information of children with torticollis.study the types and incidence of torticollis disease spectrum,compare the composition of disease spectrum in different age groups,summarize the data of torticollis visiting departments.Based on the results of this study,the diagnostic flow char of torticollis was revised by balancing diagnostic accuracy,timeliness,compliance and health economics factors based on outpatient diagnosis and treatment experience,intra-hospital multidisciplinary collaboration and existing literature.2 A single-center retrospective study was conducted to collect data from children with postural torticollis from 2019 to 2021.Children were divided into control group(physiotherapy)and experimental group(physiotherapy plus massage combined with Huoxue Roujin ointment)according to the inclusion and discharge standards.The data of two groups were compared in cervical rotation PROM(PROM-CR),cervical lateral bending PROM(PROM-CLB),average root mean square(AVG-RMS)of relaxed sternocleidomastoid muscle,maximum root mean square(Max-RMS)of contracted sternocleidomastoid muscle,torticollis severity grade before treatment and after 2 months of treatment.3 A single-center retrospective study was used to collect the data of CMT children from 2018 to 2021.Children were divided into control group(massage)and experimental group(massage combined with Huoxue Roujin ointment)according to the inclusion and discharge standards.The data of two groups were compared in PROM-CR,PROM-CLB,sternocleidomastoid muscle thickness,and torticollis severity grade of the two groups before treatment and after 2 months of treatment.4 A single-center prospective study was conducted to select healthy infants from 2022 to 2023.Sternocleidomastoid length(SCML),sternocleidomastoid length absolute increment(SCML-AI),SCME and cervical rotation/lateral bending PROM of 20 infants were collected in supine neutral position,cervical rotational extension position,cervical lateral bending extension position and cervical rotation-lateral bending-flexion extension position,and their intragroup correlation coefficients(ICC)were assessed.Above data of 42 healthy infants were collected,pearson correlation coefficients between SCML,SCML-AI,SCME,cervical PROM and age/height were calculated.Pearson correlation coefficient between SCML,SCML-AI,SCME and cervical PROM of was analyzed.SCME effect of cervical drafting of rotation-lateral bending-forward flexion,cervical drafting of rotation and cervical drafting of lateral bending were initially compared.Results:1 Disease spectrum and diagnostic flow chart of torticollis in children(1)A total of 2047 patients with torticollis were included in this study.A total of 1961 causes in 26 categories were found in 1935 patients,and no definite causes were found in 112 patients.76.5%were infants,15.0%were young children,5.1%were preschool children,and 3.3%were school-age children.(2)The top ten disorders of torticollis were CMT(51.2%),postural torticollis(27.0%),cerebral palsy(5.1%),ocular torticollis(4.7%),brachial plexus injury(2.1%),atlantoaxial rotatory subluxation(1.3%),tumor(0.8%),Tourette syndrome(0.6%),benign paroxysmal torticollis(0.5%)and congenital osseous torticollis(0.4%).(3)The disease composition of each age group was significantly different(P<0.05).The top three diseases of infantile torticollis were CMT(57.5%),postural torticollis(31.0%)and ocular torticollis(2.6%).The top three diseases of torticollis in young children were CMT(39.9%),postural torticollis(16.9%)and cerebral palsy(14.6%).The top three preschool torticollis diseases were cerebral palsy(33.3%),CMT(13.3%)and ocular torticollis(12.4%).Atlantoaxial rotatory subluxation(23.5%),CMT(16.2%)and Tourette syndrome(14.7%)were the top three diseases of torticollis in school-age children.(4)Among 2047 patients in the rehabilitation department,departments of patients visiting other departments due to torticollosis were orthopedics(29.4%),ophthalmology(16.2%),otolaryngology head and neck surgery(6.3%),neurology(4.5%),stomatology(including maxillofacial surgery)(2.1%),thoracic surgery(0.9%),oncology(0.4%)and rheumatology(0.05%).(5)The diagnostic flow chart of torticollis was revised.2 A retrospective study of massage combined with Huoxue Roujin ointment in the treatment of postural torticollis(1)A total of 91 children met the inclusion and discharge standards,including 34 cases in the experimental group and 57 cases in the control group;The general data differences between two groups were not statistically significant(P>0.05).(2)After 2 weeks of treatment,the recovery rate(58.8%)in the experimental group was significantly higher than that(33.3%)in the control group(P<0.05).(3)After 2 weeks of treatment,torticollis severity grade,PROM-CR,PROM-CLB and AVG-RMS in both groups were significantly better than those before treatment,and those in the experimental group were better than those in the control group(P<0.05);after 2 weeks of treatment,Max-RMS in the experimental group were significantly higher than that before treatment(P<0.05),and that in the control group was not significantly higher than that before treatment(P>0.05),and there was not significantly different between the experimental group and the control group(P>0.05).3 A retrospective study of massage combined with Huoxue Roujin ointment in the treatment of CMT(1)A total of 66 children met the inclusion and discharge standards,including 38 cases in the experimental group and 28 cases in the control group;The general data differences between the two groups were not statistically significant(P>0.05).(2)After 2 months of treatment,the recovery rate(34.2%)in the experimental group was higher than that(21.4%)in the control group,but the difference was not statistically significant(P>0.05).(3)After 2 months of treatment,torticollis severity grade,PROM-CR,PROM-CLB and sternocleidomastoid thickness in both groups were significantly better than those before treatment,and those in the experimental group were better than those in the control group(P<0.05).4 A preliminary study of CMT potential evaluation index:sternocleidomastoid extensibility(1)ICC for SCML measurement was 0.89-0.91,ICC for SCML AI was 0.79-0.88,ICC for SCME was 0.61-0.73,and ICC for cervical PROM was 0.83-0.89.(2)SCML and SCML-AI were positively correlated with age and height(P<0.05).SCME and cervical PROM were not correlated with age and height(P>0.05).(3)Pearson correlation coefficient between SCML and cervical PROM was 0.068-0.121,with no statistical significance(P>0.05).Pearson correlation coefficient between SCLL-AI and cervical PROM was 0.477 to 0.484,with statistical significance(P<0.05).Pearson correlation coefficient between SCME and cervical PROM was 0.763 to 0.821,with statistical significance(P<0.05).(4)Cervical drafting of rotation-lateral bending-flexion could extend sternocleidomastoid muscle 28.1 ± 3.4%,simple rotation-extension could extend sternocleidomastoid muscle 21.2 ± 2.0%,and simple lateral flexion could extend sternocleidomastoid muscle 19.7 ± 1.9%,and the difference was statistically significant(P<0.05.Conclusions:1 The study is the most extensive study of torticollis disease in children so far.The spectrum of torticollis in children is complex and the incidence varies greatly,and the spectrum composition and incidence of diseases in different age groups are different,and there are many clinical departments involved in torticollis in children,and there are certain difficulties in diagnosis.This disease spectrum information and the revised diagnosis flow chart of torticollis provide an important reference for the diagnosis of torticollis,help to reduce costs,improve diagnostic efficiency,reduce misdiagnosis,and remind the need to pay attention to multidisciplinary collaboration.2 The clinical effect of massage combined with Huoxue Roujin ointmenty for postural torticollis is superior to physical therapy,and it is a preferred diagnostic therapy for postural torticollis.3 Massage combined with Huoxue Rojin paste in the treatment of CMT was superior to massage in improving torticollis severity grade,cervical PROM and sternocleidomastoid thickness,which verified the efficacy of hospital protocol.4 The reliability of this method in measuring SCME is good,and the correlation between SCME and cervical PROM is better than that between SCML/SCML-AI and cervical PROM,SCME can be used as a potential CMT evaluation method.The preliminary application of SCME shows that the cervical drafting of rotation-lateral bending-flexion is preferred for children with mild SCME limitation;for children with moderate SCME limitation,the cervical drafting of rotation-lateral bending-flexion and/or rotation are preferred;for children with severely limited SCME,the cervical drafting of rotation-lateral bending-flexion,rotation and/or lateral bending can be selected.This is a preliminary exploration of the efficient and standardized CMT drafting scheme.