Clinical efficacy and influencing factors of positional brachycephaly treated with cranial remolding orthoses

doi:10.11852/zgetbjzz2023-1277

Abstract

Abstract: Objective To evaluate the efficacy and influencing factors of cranial remolding orthoses (CRO) in the treatment of infant positional brachycephaly (PB),in order to provide scientific basis for optimizing the treatment strategy of CRO. Methods A total of 63 infants with PB who received CRO treatment at the Beijing United Family Hospital from September 2018 to February 2022 were collected.Three-dimensional laser scanning technology was used to measure the Cephalic Ratio (CR),calculate the rate of head shape change.The efficacy and influencing factors of CRO treatment were analyzed. Results After CRO treatment,the CR value of infants with PB improved significantly (t=16.97,P<0.001).There was a significant difference in the treatment time among different groups of CRO onset months,with the 4- to 5-month-old age group being significantly shorter than the 8-month-old and above group (H=9.611,P<0.05).There was a negative correlation between the age of initial treatment and the rate of head shape change (r=-0.592,P<0.001).The severity of PB at the beginning of treatment was positively correlated with the rate of head shape change (r=0.498,P＜0.001).Comorbidity with plagiocephaly was correlated with the rate of head shape change (Z=-2.115,P＜0.05).Prematurity was not significantly correlated with the rate of head shape change (Z=-1.424,P>0.05). Conclusions CRO has a significant effect on the treatment of infant PB.The younger the age,the shorter the treatment time,and the more severe the PB,the higher the treatment efficiency.The treatment efficiency of infants with concurrent plagiocephaly is affected.It is recommended that pediatricians diagnose the PB as early as possible and recommend wearing CRO for treatment,especially for severe PB,to achieve better treatment outcomes.

Key words: positional brachycephaly, cranial remolding orthoses, orthopedic helmet

摘要： 目的本研究旨在评估头型矫正器(CRO)治疗婴儿姿势性平头畸形的临床效果及影响因素,为优化CRO的治疗策略提供科学依据。方法研究共收集2018年9月-2022年2月北京和睦家医院儿科头型矫正门诊接受CRO治疗的姿势性平头畸形婴儿63例。利用三维激光获取技术测量头颅宽长比值(CR),计算头型变化率。分析CRO治疗效果及影响因素。结果经CRO治疗后,姿势性平头畸形婴儿的CR值有显著改善(t=16.97,P＜0.001)。治疗时间在不同CRO起始月龄组别间存在显著差异,4～5月龄组明显短于8月龄以上组(H=9.611,P＜0.05)。起始治疗月龄与头型变化率呈负相关(r=-0.592,P＜0.001);起始治疗时平头畸形严重程度与头型变化率呈正相关(r=0.498,P＜0.001);伴斜头畸形与头型变化率相关(Z=-2.115,P＜0.05);早产与头型变化率无明显相关(Z=-1.424,P＞0.05)。结论 CRO治疗婴儿姿势性平头畸形效果显著。月龄越小,治疗时间越短,且平头畸形越严重,治疗效率越高。伴有斜头畸形的婴儿治疗效率受影响。建议对于姿势性平头畸形尤其是严重平头畸形尽早诊断,尽早佩戴CRO进行治疗,以获得更好的临床效果。

关键词: 姿势性平头畸形, 头型矫正器, 矫形头盔

CLC Number:

R725.6

WU Xiaoyan, SHANG Meichen, LIU Hua, DAI Na, ZHU Hongjing, YANG Ming. Clinical efficacy and influencing factors of positional brachycephaly treated with cranial remolding orthoses[J]. Chinese Journal of Child Health Care, 2024, 32(12): 1300-1303.

吴晓燕, 尚美辰, 刘华, 戴娜, 朱红静, 杨明. 头型矫形器治疗姿势性平头畸形的临床效果及影响因素[J]. 中国儿童保健杂志, 2024, 32(12): 1300-1303.

References

[1] Marshall JM,Shahzad F.Safe sleep,plagiocephaly,and brachycephaly: Assessment,risks,treatment,and when to refer[J].Pediatr Ann,2020,49(10):e440-e447.
[2] Ahluwalia R,Foster J,Sherburn MM,et al.Deformational brachycephaly: The clinical utility of the cranial index[J].J Neurosurg Pediatr,2020,26(2):122-126.
[3] Yang W,Hu B,Chen J,et al.Analysis of cranial type characteristics in term infants: A multi-center study[J].BMC Pediatr,2021,21(1):20.
[4] Kelly KM,Joganic EF,Beals SP,et al.Helmet treatment of infants with deformational brachycephaly[J].Glob PediatrHealth,2018,5:2333794X18805618.doi:10.1177/2333794×18805618.
[5] Holowaka MA,Reisner A,Giavedoni B,et al.Plagiocephaly Severity Scale toaid in clinical treatment recommendations[J].J Craniofac Surg,2017,28(3):717-722.
[6] Wilbrand JF,Wilbrand M,Malik CY,et al.Complications in helmet therapy [J].J Craniomaxillofac Surg,2012,40(4):341-346.
[7] Linz C,Kunz F,Böhm H,et al.Positional skull deformities[J].Dtsch Arztebl Int,2017,114(31-32):535-542.
[8] 马良,董荣芝,裴连平,等.扁头综合征的危险因素[J].中国康复理论与实践,2015,21(3):326-329.
Ma L,Dong RZ,Pei LZ,et al.Risk factors for plagiocephaly and brachycephaly[J].Chin J Rehabilitation Theory and Practice,2015,21(3):326-329.(in Chinese)
[9] Hallac RR,Ajiwe T,Effendi M,et al.Molding helmet therapy for deformational brachycephaly[J].J Craniofac Surg,2019,30(6):1756-1759.
[10] Teichgraeber JF,Seymour-Dempsey K,Baumgartner JE,et al.Molding helmet therapy in the treatment of brachycephaly and plagiocephaly[J].J Craniofac Surg,2004,15(1):118-123.
[11] Hinken L,Willenborg H,Dávila LA,et al.Outcome analysis of molding helmet therapy using a classification for differentiation between plagiocephaly,brachycephaly and combination of both[J].J Craniomaxillofac Surg,2019,47(5):720-725.
[12] van Cruchten C,Feijen MMW,van der Hulst RRWJ.Helmet therapy for positional cranial deformations:A 5-year follow-up study[J].J Craniomaxillofac Surg,2022,50(6):499-503.
[13] Çevik S,Işιk S,Özkιlιç A.The role of age on helmet therapy in deformational plagiocephaly and asymmetric brachycephaly[J].Childs Nerv Syst,2020,36(4):803-810.
[14] Hinken L,Willenborg H,Davila LA,et al.Outcome analysis of molding helmet therapy using a classification for differentiation between plagiocephaly,brachycephaly and combination of both[J].J Craniomaxillofac Surg,2019,47(5):720-725.
[15] Choi H,Lim SH,Kim JS,et al.Outcome analysis of the effects of helmet therapy in infants with brachycephaly[J].J Clin Med,2020,9(4):1171.