位置性斜头畸形的临床分类（即常见的婴儿头型分类）

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发布：2021-12-03 14:53:52

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作者：路易斯·阿根塔发布刊期：颅面外科杂志/第15卷
发布时间：2004年5月3日
Purpose:
Studies have shown that there are many methods to evaluate the degree of deformity, all of which are expensive, time-consuming and poor repeatability. The purpose of this study is to propose a clinical observation classification method that can be individualized according to the degree of infant deformity and reassess its repeatability over time.
目的：
研究显示有多种评估畸形程度的方法，所有这些方法都很昂贵、耗时，而且重复性差。这项研究旨在提出根据婴儿畸形程度，进行个体化，并随着时间的推移可重新评估的重复性的临床观察分类方法。

Methods:
All patients are examined clinically in four positions. The first is looking directly anteriorly at the child while holding the child in a straight for-ward gazing position. This allows the Physician to determine if there are asymmetries of the forehead and of the face. It is also helpful in determining ear position but not as helpful as other views. Concomitant disorders such as torticollis may be identified as well.

The second position of examination is with the child seated in the physician’s lap, with the head vertex observed from above. The nose is pointed straight forward, usually with the patient’s family holding the infant’s attention. The index fingers of the examining physician are then placed in the each external auditory canal, and the patient is examined from directly above. This allows evaluation of forehead asymmetry, posterior cranial asymmetry, and malposition of the ears. Abnormal bulging of the temporal fossa is most easily seen in this view.

The third clinical examination position is posterior to the infant’s posterior skull. This can either be done in the physician’s lap, on the table, or while a member of the patient’s family holds the child. This position allows confirmation of ear position and posterior asymmetry. In addition, it allows evaluation of widening of the posterior skull.

The fourth position is a direct lateral view. This allows the physician to determine any degree of abnormal vertical growth of the skull, which can occur in severe plagiocephaly when the restrained brain attempts to decompress.
方法：
自1996年威克森林大学北卡罗莱纳州裂隙和颅面畸形研究所对3000多名畸形性斜头畸形儿童进行了评估，所有患者在四个体位进行临床检查。
第一种是直接向前看孩子，同时将孩子抱在一个直视的位置。这允许医生确定前额和面部是否不对称。它也有助于确定耳朵位置，但不像其他视图那样有用。同时，也可发现斜颈等伴随疾病。
第二个检查位置是让孩子坐在医生的大腿上，从上方观察头部顶点。鼻子笔直向前，通常由患者的家人引起婴儿的注意。然后将检查医生的食指放在每个外耳道中，从正上方检查患者。这允许评估前额不对称、后颅不对称和耳朵错位。在这张图中最容易看到颞窝异常隆起。
第三个临床检查位置位于婴儿后颅骨后方。这可以在医生膝上、在手术台上进行，也可以在患者家庭成员抱着孩子时进行。这个位置允许确认耳朵位置和后部不对称。此外，它允许评估后颅骨的加宽。
第四个位置是直接侧面视图。这使得医生能够确定任何程度的颅骨垂直生长异常，当受约束的大脑试图减压时，这可能发生在严重的斜头畸形中。异常在临床上是可见的，或根据是否存在进行分类。不进行拟人测量。临床上不存在需要精确测量的微小异常。

result:
The classification used in this study is based only on clinical observations. It enables us to accurately quantify the degree of deformity in any patient. More importantly, it allows us to quantify malformations in subsequent clinical visits. This allows us to determine the effectiveness of any treatment, whether it is observation alone, localization or helmet therapy. It is helpful to quantify the ability of existing malformations and let parents know that their children are improving after receiving the prescribed treatment, and the situation will be worse if there is no compliance.
结果：
本研究中使用的分类仅基于临床观察。它使我们能够准确地量化任何患者的畸形程度。更重要的是，它允许我们在随后的临床访视中量化畸形。这使我们能够确定任何治疗的有效程度，无论是单独观察、定位还是头盔治疗。量化现有畸形的能力是有帮助的，并使父母了解到，孩子在接受规定的治疗后正在好转，如果没有依从性，情况会更糟。

Conclusion:
Clinical classification of deformational cranial deformities allows accurate communication between health care professionals and families without labor-intensive measurements or prolonged radiographic exposure. Furthermore, it can be used as a way to evaluate therapeutic outcome and the need for additional workup. Finally, it is a useful tool to help predict the optimal type and duration of therapy for the correction of these deformities.
结论：
变形性颅骨畸形的临床分类允许医疗保健专业人员和家庭之间进行准确的沟通，无需劳动密集型测量或长时间的射线照射。此外，它可以作为一种评估治疗结果和需要额外检查的方法。最后，它是一个有用的工具，能有助于预测矫正这些畸形的最佳治疗类型和持续时间。

相关研究论点：
1、研究表明小于4个月的婴儿，经常在6周内从III型头骨变为I型头骨，年龄较大的儿童（即9个月以上的儿童）经常需要更长的时间来纠正错误，事实上，可能无法完全纠正错误。矫正这种畸形通常需要更长的时间，并且再次与开始治疗时的儿童年龄相关。因此，孩子头型矫正需要早发现，早治疗。