作者：苏珊娜· 克拉布    发布期刊 : 颅面外科杂志，第23卷，第5期     
发布时间：2012年9月

Background:
Helmet therapy is widely accepted in the treatment of severe positional plagiocephaly. The improvement of the cranial asymmetry under therapy is evident, but parents are also concerned about the ear shift. Our study investigated the influence of helmet therapy on the position of the ears and analyzed the reliability of clinical observations regarding cranial asymmetry and ear shift.
目的：
头盔疗法被广泛接受用于治疗严重的位置性斜头畸形。治疗后，头颅不对称改善明显，但家长也关注到头盔矫正对耳位的移动影响。这项研究调查了头盔治疗对耳位的影响，并分析了临床观察中头盔矫正对头颅不对称和耳移位影响的可靠性。

Methods:
Three-dimensional stereophotogrammetry of 80 infants with severe positional plagiocephaly was performed before and after helmet therapy. The cranial vault asymmetry index (CVAI) and ear shift were measured and statistically compared. The correlation between the change of CV AI and ear shift was investigated. Three surgeons visually evaluated the treatment results on three-dimensional images independently with a standard questionnaire. The results were compared with the three-dimensional measurement.
方法：
通过三维立体摄影测量，对80例重度位置性斜头畸形患儿进行头盔治疗前后对比。对颅顶不对称指数(CVAI)和耳移测量，并进行统计学对比，来研究CVAI的变化与耳移的相关性。三位外科医生独立通过标准问卷在三维图像上直观评估治疗结果。最终矫正结果与三维测量结果进行了比较。

Results:
Sixty infants had a relevant initial ear shift. Under therapy, the shift was improved significantly by a mean of 29.8% (PG0.001). Twenty infants with an initial straight ear line statistically deteriorate under therapy (PG0.0001). We found no strong linear correlation between the changes of the CV AI and the ear shift. Analysis of the questionnaire revealed a good correlation between the clinical impression and three-dimensional measurements for the head asymmetry, whereas observations regarding changes in the ear shift were not reliable.
结果：
60例婴儿耳移位与头盔矫正有直接关联情况。在治疗下，移位显著改善，平均29.8% (PG0.001)。20例初始耳线呈直线的婴儿在治疗后统计恶化(PG0.0001)。我们发现CVAI的变化与耳移之间没有很强的线性相关性。调查问卷的分析显示临床检测和头部不对称的三维测量之间有很好的相关性，而通过观察来判断耳移位变化是不可靠的。

Conclusions:
Helmet treatment significantly improves an initial malposition of the external ear in infants with positional plagiocephaly. A severe ear shift can be associated with a moderate CVAI and vice versa. In contrast to the CVAI, small changes of the ear shift cannot be evaluated reliably by clinical investigation.
结论：
头盔治疗可显著改善位置性斜头畸形婴儿导致的最初外耳位置失调。严重的耳移位可能与中度CVAI相关，反之亦然。与CVAI相比，耳移位的微小变化不能通过临床研究可靠地评估。

本研究的相关论点：
1、研究发现头戴头盔治疗后,1组患者耳移位平均减少1.4度(SD为1.5度)，这相对于最初存在的错位的平均改善29.8%，头盔治疗不仅对位置性斜头畸形婴儿的颅骨不对称性有积极影响，它也会改变耳朵的位置。

2、本文研究头盔治疗是否能改善这些婴儿的耳移位，结果表示头戴头盔治疗后,1组患者耳移位平均减少1.4度(SD为1.5度)；虽然2组婴儿没有可见的初始耳移位，但在头盔治疗下也观察到变化。但头盔治疗后耳移变化的系数和CVAI变化为弱关系。

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