197例新生儿骨折临床分析  

Analysis of 197 Cases of Neonatal Fracture

作　　者：陈文昊[1] 杨长仪[2] 张宝泉[2] 

机构地区：[1]福建医科大学附属协和医院骨科,福州350001 [2]福建医科大学教学医院福建省妇幼保健院新生儿科,福州350001

出　　处：《福建医科大学学报》2015年第2期123-126,共4页Journal of Fujian Medical University

摘　　要：目的：探讨新生儿骨折常见原因、诊疗及预防。方法回顾性分析197例新生儿骨折的临床资料，调查孕母情况、分娩情况、患儿一般情况、骨折诊疗及预后等情况。采用χ2检验分析不同骨折原因下新生儿骨折部位构成的差异性、不同分娩方式及出生体质量下产伤性骨折部位构成的差异性。结果产伤性骨折193例，其中自然分娩165例，产钳助娩9例，臀位助娩5例，胎吸助娩2例，剖宫产12例；产伤性骨折患儿出生体质量14例＜2．5 kg ，150例2．5～4 kg ，29例≥4 kg ；非产伤性骨折4例，其中代谢性骨病骨折3例；先天性成骨不全骨折1例。骨折好发部位前3位依次为锁骨（178例）、颅骨（10例）、股骨（5例），不同骨折原因下新生儿骨折部位构成存在差异（χ2＝57．87，P＜0．001）；不同分娩方式下产伤性骨折部位构成存在差异（χ2＝75．02，P＜0．001）；不同出生体质量下产伤性骨折部位构成存在差异（χ2＝36．48，P＜0．001）。3例代谢性骨病骨折患儿胎龄均＜31周，2例出生体质量＜1000g，1例＜1500g，骨折时日龄≥35d，肠外营养时间均≥33d，2例呼吸机撤离困难，2例血钙降低，3例血磷降低，1例碱性磷酸酶升高。结论新生儿骨折以产伤性骨折为主，骨折发生部位与分娩方式、新生儿出生体质量等因素有关；代谢性骨病是非产伤性骨折的重要原因，与矿物质储备、出生后钙、磷及维生素D摄入等相关。预防上主要为提高助产技术，并注意早产儿营养管理。Objective To investigate common causes ,diagnosis ,treatments and prevention of neonatal fracture . Methods A retrospective study was conducted to investigate the fracture in newborn . Information analyzed included maternal record ,delivery ,neonatal records . Chi‐Square test was used to analyze the statistical significance in different fracture sites which were caused by different reasons ,by dif‐ferent delivery methods and in different birth weights . Results Among a total of 193 newborns with birth traumatic fracture ,165 cases had natural delivery ,9 cases had forceps delivery ,5 cases had breech delivery ,2 cases had vacuum extraction delivery ,12 cases had cesarean delivery ;of all with birth tramatic fracture ,14 cases were below 2 .5 kg ,150 cases were between 2 .5 and 4 .0 kg ,29 cases were above 4 kg . Among the 4 cases that were not with birth traumatic fracture ,3 cases had metabolic bone diseases , 1 cases had osteogenesis imperfecta . The primary sites were clavicle（178） ,skull（10） ,and thighbone （5） . There was a significant correlation between fracture reasons and fracture sites （χ2 = 57 .87 , P〈0 .001） ,delivery methods and birth traumatic fracture sites（χ2 =75 .02 ,P〈0 .001） ,birth weight and birth traumatic fracture sites（χ2 =36 .48 ,P〈0 .001） . Of 3 metabolic bone disease （MBD） infants ,the gestational age was less than 31 weeks ,2 of whom weighted less than 1 000 g and 1 less than 1 500 g . Age of fracture more than 35 d ,parenteral nutrition time was 33 days or more . Two needed to be sup‐portedwith ventilator ,2 had blood calcium reduction ,3 had blood phosphorus reduction ,and 1 had alka‐line phosphatase elevation . Conclusions The primary newborn fracture type was birth traumatic frac‐ture ,and its sites were related with delivery methods ,newborn weight . MBD was the main reason that causes non birth‐traumatic fracture ,and was associated with mineral reservation ,inadequate intake or me‐tabolism of calcium ,phosphorus ,vitamin D . Impro

关 键 词：新生儿 骨折 产伤性骨折 代谢性骨病 

分 类 号：R722.141[医药卫生—儿科] R726.83[医药卫生—临床医学]