Objective: To investigate the diagnosis and efficacy evaluation of ultrasound two-dimensional shear wave elastography and real-time tissue elastography in children with congenital muscular torticollis. Methods: The clinical data of 105 children with suspected congenital muscular torticollis were selected for retrospective analysis. The study period was from February 2017 to February 2020. A total of 52 cases were confirmed pathologically as congenital muscular torticollis ( 33 cases of mass type and 19 cases of diffuse type); both were given ultrasound two-dimensional shear wave elastography and real-time tissue elastography to evaluate the sensitivity, specificity, Youden index, cut-off value after the examination, and analyze the emean value and ROC curve of SR value, and emean value and SR value after evaluation. Results: The positive predictive value of 105 children with suspected pediatric congenital muscular torticollis was 96.14% and the negative predictive value 96.23% after two-dimensional shear wave elastography detection; the same as the pathological results (P>0.05) . After real-time tissue elastography technology, the positive predictive value was 80.77%, and the negative predictive value was 81.13%, which was lower than the pathological result (P＜0.05). A total of 52 children with congenital muscular torticollis were detected by two-dimensional shear wave elastography and there were 32 cases of mass type and 18 cases of diffuse type; a total of 30 cases of mass type and diffuse type were detected by real-time tissue elastography. 12 cases; there was a significant difference between the two groups (P<0.05). The Emean value and SR ratio of the mass type and the diffuse type were higher than those of the healthy side (P<0.05); the Emean value and SR ratio of the mass type were lower than that of the diffuse type (P<0.05). The AUC value of the area under the Emean value curve is (0.975, P＜0.05), the sensitivity is 94.70%, the specificity is 94.10%, the Youden index is 0.888, and the cut-off value is 24.725; the AUC value of the area under the SR ratio curve is (0.922, P＜ 0.05), sensitivity 100.00%, specificity 77.60%, Youden index 0.776, cut-off value 2.785. The Emean value and SR ratio of surgical treatment were lower than those of non-surgical treatment (P<0.05). The Emean value of 52 children with congenital muscular torticollis after non-surgical treatment was (20.21±1.21), and the SR ratio was (3.02±0.45); there was no statistical significance compared with before treatment (P>0.01); For surgical treatment, the Emean value after surgery was (8.23±1.06), and the SR ratio was (0.67±0.14), which were both lower than before treatment (P<0.05). Conclusion: Both two-dimensional shear wave elastography technology and real-time tissue elastography technology can provide reference value for clinical diagnosis, but the former has a higher diagnosis rate.