新生儿颅骨凹陷性骨折负压抽吸术治疗方法的研究

Role of negative pressure suction for depressed skull fractures in neonates

目的探讨真空负压吸引术治疗新生儿颅骨凹陷性骨折并文献复习,了解新生儿颅骨凹陷的临床特点及选择合理的治疗方案。方法回顾性分析华中科技大学同济医学院附属武汉儿童医院1997年1月至2017年1月收治的18例新生儿颅骨凹陷性骨折,其中11例采取保守观察,7例采用产科负压吸引器负压吸引复位,年龄为2 h至25 d,凹陷深度为0.3~1.3 cm。结果18例患儿均在出生后即发现颅骨凹陷性骨折,均为顶骨凹陷,其中16例为剖宫产,2例顺产(其中1例难产)。11例采取保守观察的患儿于出生后1~7个月骨折自行复位,复位时间与凹陷深度呈明显正相关(r=0.875,P<0.05)。其中6例凹陷深度大于0.5 cm,平均自行复位时间为4.5个月。7例采取真空负压抽吸术,其中6例负压抽吸治疗后颅骨凹陷立即复位,1例于出生25 d才就诊,复位失败。所有采取真空负压抽吸术的患儿未发生颅内出血或原有出血加重等并发症。结论采用负压抽吸术,只要掌握好适应证及操作方法,不仅可立即复位凹陷性骨折,也不会造成患儿严重医源性伤害,出生后越早行负压抽吸越容易成功复位。

Objective To explore the role of negative pressure for managing simple depressed skull fractures in neonates and review the relevant literatures. Methods Retrospective reviews were performed for medical records of 18 hospitalized neonates with depressed skull fractures from 1997 to 2017. They underwent spontaneous elevation (n=11) or negative pressure suction (n=7). Their admission age was from 2 hours to 25 days. And the depth of depression was from 0.3 to 1.3 cm. Results Among them, 16/18 were delivered via Cesarean section. One of two natural delivery was of dystocia. All fractures were located in parietal bone. Spontaneous restoration of depression was achieved in 11 patients within a period of 1 to 7 months. And reset time and depth of depression had a significant positive correlation (r=0.875, P<0.05). The average time of spontaneous restoration was 4.5 months that the depth of depression was >0.5 cm (n=6). Six cases recovered immediately without complications after vacuum extraction and only 1 case failed in one patient with the age of 25 days. All vacuum-extracted neonates had no such complication as intracranial hemorrhage or aggravation of existing hemorrhage. Conclusions With negative pressure aspiration, as long as indications and operative approaches are properly mastered, not only concave fracture may be reduced immediately, but also serious iatrogenic injury is avoided. The earlier negative pressure section is performed postnatally, the easier it can be reduced successfully.