Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea.
Med Hypotheses. 2010 May;74(5):898-900. doi: 10.1016/j.mehy.2009.11.014. Epub 2009 Dec 14.
Vaginal delivery is accomplished by the force of the labor overcoming the resistance forces of birth canal. During this process, the fetal head passes through the birth canal and the skull receives pressure on the lateral aspect, resulting in molding, the convex shaping of the cranium. Also, the infant's skull is compressed by the mother's pelvic bony structures. These forces may lead to skull fractures and brain injuries. The hypothesis by the authors is that many skull fractures of the newborn present as incomplete fractures. The bony skull of the newborn is histologically primary bone tissue and which is incomplete in its ossification process. During birth the pressure forces upon the newborn's skull is gradual in one direction, rather than a sudden impact, and therefore it is thought that the skull fracture would be an incomplete fracture. However, it is very hard to ascertain the presence of incomplete fractures especially in incompletely ossified skulls with plain X-ray studies, and therefore it is possible that the real incidence of skull fractures in the newborn are higher than reported in the current and past literature. It is also probable that the external forces upon the skull that are sufficient to cause skull fractures, would also lead to significant brain injury more frequently than actually observed, and subsequently contribute to development of many brain disease later in children. The authors of this study propose that very close examination should be conducted to find incomplete fracture, and increased efforts should be made to establish the presence of possible accompanied brain injuries in babies with incomplete skull fracture. The definitive diagnosis and treatment, as well as close follow up of patients with brain injury will assist the clinician in determining the causes of neurological diseases especially in those with previously unknown etiologies, which may be due to birth injuries. Assistance may be also afforded in the early treatment and prevention of such conditions.
阴道分娩是通过劳动力克服产道阻力来完成的。在此过程中，胎儿头部通过产道，头骨侧面受到压力，导致塑形，即头骨凸面成形。此外，婴儿的头骨也受到母亲骨盆骨结构的挤压。这些力量可能导致头骨骨折和脑损伤。作者的假设是，许多新生儿的头骨骨折表现为不完全骨折。新生儿的骨性头骨在组织学上是初级骨组织，其骨化过程尚未完全完成。在分娩过程中，新生儿头骨所承受的压力是逐渐的，而不是突然的冲击，因此人们认为头骨骨折是不完全骨折。然而，要确定不完全骨折的存在，尤其是在不完全骨化的头骨的普通 X 光研究中，这非常困难，因此，新生儿头骨骨折的实际发生率可能高于目前和过去文献中的报告。也有可能是足以导致头骨骨折的头骨外部力量更频繁地导致比实际观察到的更严重的脑损伤，随后导致许多儿童后期的大脑疾病。本研究的作者提出，应该进行非常仔细的检查以发现不完全骨折，并应努力确定不完全头骨骨折婴儿是否存在可能伴随的脑损伤。明确的诊断和治疗，以及对脑损伤患者的密切随访，将有助于临床医生确定神经疾病的原因，特别是对于那些以前病因不明的疾病，这可能是由于分娩损伤引起的。早期治疗和预防这些情况也可能得到帮助。
