Helmet versus non-helmet treatment in infants with positional cranial deformation: A systematic review and meta-analysis

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-06-26 DOI:10.1016/j.jocn.2025.111431

Yan Gondim de Sousa , Thiago Luís Marques Lopes , Áquila Matos Soares , Marconny Alexandre Cavalcante , Júlio Farias Rangel , Leonardo de Macedo Filho , Mateus Dutra Balsells , Daniel Andrade Gervásio , Isabela Fernandes de Melo Pereira , Andressa Gabriella Duarte de Queiroz , Miguel Vieira de Almeida , George Pessoa Amorim Neto , Cintia Gonçalves Urbano Cavalcante , Lucas Alverne Freitas de Albuquerque

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引用次数: 0

Abstract

Background

Active repositioning and cranial orthoses are the primary treatment choices for positional cranial deformation (CD). However, the superiority of helmet therapy over non-helmet therapies remains controversial. We conducted a meta-analysis of cranial asymmetry (CA) parameters from studies comparing helmet therapy to non-helmet therapy in infants with non-synostotic CD.

Methods

We systematically reviewed the literature from PubMed, Embase, and Cochrane databases. Exclusion criteria included lack of a control group, overlapping populations, and solely qualitative outcomes. Statistical analysis was performed using Review Manager 5.4.1.

Results

From the 788 articles identified, 13 were included, with 1189 infant patients. Treatment outcomes were measured using the Cranial Vault Asymmetry Index (CVAI), Cranial Index, and Diagonal Difference. From 10 studies incorporating all three scales, helmet were used in 509/980 (52 %) patients. The average follow-up period was 20.95 ± 23.84 months. The reduction in CA (SMD: −1.16; 95 % CI: [-1.66, −0.67]; p < 0.00001; I² = 90 %) was more pronounced in the helmet group. Using only CVAI, there was a more significant improvement in CA (SMD: −1.29; 95 % CI: [-1.97, −0.62]; p = 0.0002; I² = 90 %) in the helmet group. When subdividing the non-helmet group into natural course and repositioning, there are greater improvements in the helmet group, both in relation to the natural course group (SMD: −1.37; 95 % CI: [-2.31, −0.43]; p = 0.004; I² = 94 %) and in relation to the repositioning group (SMD: −1.16; 95 % CI: [-2.01, −0.31]; p = 0.008; I² = 64 %). Comparing only CVAI for the helmet group, we observed a significant decrease (SMD: −1.70; 95 % CI: [-2.01, −1.39]; p < 0.00001; I² = 48 %) compared to the non-helmet group (SMD: −0.54; 95 % CI: [-0.79, −0.29]; p < 0.0001; I² = 25 %).

Conclusion

Our meta-analysis demonstrated that, in the short term, helmet therapy is significantly more effective in correcting cranial positional deformities than therapy that does not use orthoses. Nonetheless, due to study limitations and high heterogeneity, caution is necessary in interpreting these results and their clinical application. More high-quality randomized clinical trials are necessary to confirm these findings and assess the long-term effects of helmet therapy.

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婴儿头盖骨位置性变形的头盔治疗与非头盔治疗：一项系统回顾和荟萃分析

背景主动复位和颅骨矫形器是定位性颅骨变形（CD）的主要治疗选择。然而，头盔治疗相对于非头盔治疗的优越性仍然存在争议。我们进行了一项meta分析，比较了头盔治疗和非头盔治疗对非心性cd患儿颅骨不对称（CA）参数的影响。方法我们系统地回顾了PubMed、Embase和Cochrane数据库的文献。排除标准包括缺乏对照组、重叠人群和仅定性结果。使用Review Manager 5.4.1进行统计分析。结果在788篇文献中，纳入13篇，1189例婴儿患者。使用颅穹不对称指数（CVAI）、颅指数和对角差测量治疗结果。在纳入所有三种量表的10项研究中，509/980例（52%）患者使用了头盔。平均随访20.95±23.84个月。CA降低(SMD:−1.16；95% ci: [-1.66, - 0.67]；p & lt;0.00001;I2 = 90%)在头盔组更为明显。仅使用CVAI， CA的改善更为显著(SMD:−1.29；95% ci: [-1.97, - 0.62]；p = 0.0002；I2 = 90%)。当将非头盔组细分为自然路线组和重新定位组时，头盔组与自然路线组相比有更大的改善(SMD:−1.37；95% ci: [-2.31, - 0.43]；p = 0.004；I2 = 94%)，与重新定位组相关(SMD:−1.16；95% ci: [-2.01, - 0.31]；p = 0.008；i2 = 64%)。仅比较头盔组的CVAI，我们观察到显著降低(SMD: - 1.70；95% ci:[-2.01,−1.39]；p & lt;0.00001;I2 = 48%)与未戴头盔组相比(SMD:−0.54；95% ci: [-0.79, - 0.29]；p & lt;0.0001;i2 = 25%)。结论：我们的荟萃分析表明，在短期内，头盔治疗比不使用矫形器的治疗更有效地矫正颅骨位置畸形。然而，由于研究的局限性和高度异质性，在解释这些结果及其临床应用时需要谨慎。需要更多高质量的随机临床试验来证实这些发现并评估头盔治疗的长期效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.