新生儿锁骨骨折的早期诊疗体会

摘要

目的 探讨分析新生儿锁骨骨折的临床特点及其早期诊疗体会.方法 回顾性整理分析2013年1月至2017年12月间病例资料,本院7919例新生儿中19例新生儿锁骨骨折入选观察组,另随机抽取的19例无骨折新生儿入选对照组.并对两组新生儿性别、体重;母亲年龄、孕次、产次、孕龄;以及第二产程时间、胎儿窘迫发生情况、肩难产发生情况、产钳助产情况等临床资料进行对比分析.记录和分析观察组19例新生儿锁骨骨折的发现诊断情况,骨折部位、合并神经损伤情况,以及骨折愈合随访情况.结果 7919例新生儿中19例发生锁骨骨折,骨折发生率为0.24％;1例患儿合并臂丛神经不全损伤,随访3个月后恢复正常.所有19例患者锁骨骨折均愈合,愈合时间0.7～ 1.8个月,骨折平均愈合时间(0.8±1.1)个月.一期愈合率达100％,塑形时间2～5个月,骨折平均塑形时间(2.7±3.0)个月.观察组和对照组在新生儿出生体重及肩难产两方面比较,差异有统计学意义(P＜0.05),即大体重和肩难产是导致新生儿锁骨骨折的危险因素.结论 新生儿锁骨骨折预后较理想,对于新生儿锁骨骨折的高危因素重点关注,以早期发现,规范处理,预防并发症的发生,有利于医患关系.%Objective To investigate and analyze the clinical characteristics of and early diagnosis and treatment for clavicular fracture of newborns.Methods The case data from January,2013 to December,2017 were retrospectively analyzed.Among the 7 919 neonates at our hospital,19 ones with clavicular fracture were selected as an observation group and another nineteen without fracture a control group.The sex,weight,mother age,pregnancy,birth,pregnancy age,and second stage of labor,fetal distress,shoulder dystocia,and forceps delivery in these two groups were compared and analyzed.The diagnostic basis,location of fracture,combination with nerve injury,and follow-up of fracture in the observation group were recorded and analyzed.Results Among the 7 919 neonates,nineteen had clavicular fracture,with an incidence of 0.24％;1 case complicated with brachial plexus incomplete injury and recovered to normal after 3 months' follow up.All the nineteen cases healed in 0.7 to 1.8 months,with an average healing time of (0.8±1.1) months.The primary healing rate was 100％.The plastic shaping time was 2 ～ 5 months,with an average of (2.7±3.0) months.There were significant differences in birth weight and shoulder dystocia between these two groups (P ＜ 0.05).Heavy boirth weight and shoulder dystocia were the risk factors of clavicle fracture in newborns.Conclusion Clavicular fracture of newborns has an ideal prognosis.For high-risk factors of clavicle fracture,early detection and standardized treatment are beneficial to prevention of complications and doctor-patient relationship.