Zhu Guanghui,Mei Haibo,Liu Kun,et al.Experience of diagnosing and treating neonatal humeral obstetric fracture: a report of 12 cases[J].Journal of Clinical Pediatric Surgery,2019,18(11):959-963.[doi:10.3969/j.issn.1671—6353.2019.11.012]
新生儿肱骨产伤性骨折12例诊疗分析
- Title:
- Experience of diagnosing and treating neonatal humeral obstetric fracture: a report of 12 cases
- Keywords:
- Humeral Fractures; Birth Injuries; Diagnosis; Therapy; Infant; Newborn
- 分类号:
- R726.8;R683;R722.14
- 摘要:
- 目的 探讨新生儿肱骨产伤性骨折的早期诊断和治疗方法，并评估其预后。方法 对湖南省儿童医院2006年8月至2017年1月收治的新生儿肱骨产伤性骨折病例进行回顾性分析，统计其孕周、出生体重、娩出方式、胎位、就诊年龄、受伤部位、侧别、合并损伤、治疗方法、固定时间、治疗结局等指标。结果 共12例产伤性肱骨骨折病例纳入本研究。男8例，女4例。左侧5例，右侧6例，双侧1例。孕周：<37周6例，37~42周间5例，>42周1例；出生体重（3 042.5±825.9）g；臀位7例，头位5例。肱骨干骨折9例，肱骨近端骨骺分离1例，肱骨远端骨骺分离2例。3例合并锁骨骨折，2例合并桡神经损伤，3例合并头皮血肿，1例合并臂丛神经损伤，4例无任何合并损伤。患儿转入本院的时间为出生后1~14 d。5例出生后即发现肱骨骨折，直接转入我科，其余病例均存在延迟诊断（其中3例诊断时间距发病时间>1周）。2例肱骨全骨骺分离患儿经肘关节造影确诊，其余病例均经X线片确诊。采用石膏固定3例，采用小夹板固定8例，采用弹力绷带贴胸固定治疗1例，无一例手术病例。2例患儿就诊时骨折端已有大量骨痂形成，仅予石膏或绷带原位固定，2~3周后拆除固定时均可见大量骨痂生长。随访时间18~60个月（中位时间45个月），末次随访时骨折均已骨性愈合。桡神经损伤均在3~6个月后完全恢复，1例因臂丛神经损伤未能恢复导致上肢功能障碍，1例残余肘内翻15°。末次随访时，12例（13肢）Mayo肘关节功能评分（93.8±11.8）分，优良率92.3%（12/13）；Neer肩关节功能评分（93.5±14.8）分，优良率92.3%（12/13）。结论 新生儿产伤肱骨骨折应尽早借助X线片、B超、MRI等辅助检查确诊，早期保守治疗2~3周后多愈合良好。此外，新生儿肱骨骨折塑形能力强，肱骨远端骨骺分离可能导致肘内翻，肱骨干骨折和肱骨近端骨骺分离则很少遗留后遗畸形。
- Abstract:
- Objective To explore the early diagnosis,treatment and prognosis of neonatal humeral obstetric fracture.Methods A retrospective analysis was conducted for 12 cases of neonatal humeral obstetric fracture from August 2006 to January 2017.The clinical data of gestational age,birth weight,delivery mode,placental position,age of treatment,injury site,side,combined injury,treatment method,fixing time and treatment outcomes were documented.Results There were 8 boys and 4 girls.The involved side was left (n=5),right (n=6) and bilateral (n=1).The gestational age was <37 weeks (n=6),37-42 weeks (n=5) and >42 weeks (n=1).The birth weight was (3 042.5±825.9) gram with breech presentation (n=7) and cranial projection (n=5).There were humeral shaft fracture (n=9),proximal humeral epiphysiolysis (n=1) and distal humeral epiphysiolysis (n=2).The combined injuries were clavicular fracture(n=3),radial nerve injury (n=2),scalp hematoma (n=3),brachial plexus injury (n=1).Four cases had no combined injury.The age of admission was between 1-14 days.Five patients were transferred into our department immediately after humeral fracture at birth.The diagnosis was delayed for the remainders.The diagnostic time was>1 week (n=3).Humeral epiphysiolysis (n=2) was diagnosed by elbow arthrography and the remainders were diagnosed by radiology.The fixation methods were plaster (n=3),small splint (n=8) and elastic bandage (n=1).Extensive callus formation at fracture was revealed by radiography in two cases with humeral epiphysiolysis at admission and was managed by in situ plaster or bandage.Reexamination at 2-3 weeks after removing fixation showed a large amount of callus growth.The average follow-up period was 45 (18-60) months.Radial nerve injury recovered completely within 3-6 months.One case failed to recover from brachial plexus injury and developed upper limb dysfunction.And another case 3 had a residual cubitus varus of 15 degrees.During the last follow-up,Mayo elbow function score (93.8±11.8) was obtained in 12 cases (13 limbs) with an excellent/good rate of 92.3% (12/13).Neer shoulder function score was excellent (93.5±14.8) and achieved a good rate of 92.3%(12/13).The function of shoulder and elbow joint were normal except for one.Conclusion Neonatal humeral obstetric fracture should be diagnosed with radiology,ultrasound,MRI and other auxiliary methods as soon as possible and managed by early conservative treatment.It heals well after 2-3 weeks.Neonatal humeral fracture has strong shaping ability.Distal humeral epiphysiolysis may lead to cubitus varus while humeral shaft fracture and proximal humeral epiphysiolysis scarely cause sequel deformity.
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备注/Memo
收稿日期:2019-06-05。
基金项目:湖南省自然科学基金青年基金（编号：2017JJ3140）；湖南省儿童医院"青年英才"培养计划
通讯作者:梅海波,Email:meihaibo@sohu.com