新生儿锁骨骨折44例临床分析

A Study on 44 Cases of Clavicular Fracture

目的探讨新生儿锁骨骨折发生率、高危因素和防治。方法对1994年10月～1997年12月在我科经阴道分娩的44例新生儿锁骨骨折进行回顾性分析。结果 3 135例阴道分娩新生儿中有44例发生锁骨骨折,发生率为1.4%。34例(77.26%)是在入婴儿室或出院查体时得到诊断。骨折的高危因素有:高出生体重、持续性枕位横和枕后位、第二产程停滞、产钳助产、肩难产等。但有相当比例骨折(41%)发生在无高危因素的正常阴道顺产儿中,骨折多数发生在右锁骨,37例(84%)骨折发生在前肩,可能与胎儿通过骨盆出口时助产者过度压前肩和抬后肩,使胎儿前肩受母亲耻骨联合的挤压有关。结论新生儿锁骨骨折是常见的产伤,对骨折高危因素存在的胎儿在分娩过程中应注意助产方法,对新生儿需仔细认真查体,及时诊断以防延误治疗。

Objective To investigate the incidence of the newborn's clavicle fracture,the high risk factors related to the fracture,and the possible methods to prevent and treat the fracture. Methods Forty-four newborns with fractured clavicles in our department from Sept.1994 to Dec. 1997 were analysed retrospectively.Results There were 44 newborns suffered from clavicle frac- ture in 3 135 vaginal deliveries with an incidence of 1.4%.Thirty-four cases(77.26%,34/44)were diagnosed immediately after delivery or before discharge from the hospital.The risk factors for clav- icular fracture include:high birth weight,forceps delivery,shoulder dystocia,and prolonged second stage of labor and persistent occipital transverse or posterior.However,41%(18/44)of cases had no high risk factors.The right clavicle is more likely to be affected,which may be due to the fact that the anterior shoulder was over-pressed as the infant descended through the pelvic outlet under the symphysis pubis.Conclusions Newborn's clavicle fracture is one of the common injuries in vagi- nal delivery.Close attention should be paid during delivery when any of the above mentioned high risk factor is presented,and careful examination of the newborn can not be neglected.