肩难产伴臂丛神经损伤新生儿锁骨骨折危险因素的回顾性分析：单中心经验
A retrospective analysis of risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury: A single-center experience.
机构信息
Department of Orthopedics and Traumatology, Minister of Health Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey.
Department of Obstetrics and Gynecology, University of Health Sciences School of Medicine Şanlıurfa Mehmet Akif İnan Research and Training Hospital, Şanlıurfa, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2020 Nov;54(6):609-613. doi: 10.5152/j.aott.2020.19180.
OBJECTIVE
We aimed to analyze the risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury and to determine whether their incidence is associated with local characteristics.
METHODS
This study was conducted as a retrospective trial between January 2017 and December 2018. Patients with clavicular fracture who were hospitalized in the neonatal intensive care unit of a community hospital were retrospectively analyzed. The clavicular fracture cohort was first divided into two groups and then two subgroups: patients with/without shoulder dystocia and patients with/without a brachial plexus injury. Peripartum and neonatal risk factors of these patients were reviewed using the patient information system. Any additional neurological or musculoskeletal trauma was noted. A multivariate logistic regression analysis was performed to determine independent predictors of shoulder dystocia and brachial plexus injury.
RESULTS
A total of 46 patients with shoulder dystocia in 25 (54%) and brachial plexus injury in 12 (26%) were included in the study. The birth weight of patients with shoulder dystocia was 4,164.2±412.7 g, and that of patients without was 3,535.8±865.2 g (p=0.003). In 11 of 14 patients (44%) in whom labor was induced and whose infant had a fractured clavicle, the infant also had shoulder dystocia (p=0.029). Brachial plexus injury was found in 8 (66.7%) of 14 infants who were born by induced labor and who had a clavicular fracture (p=0.002). The regression analysis revealed that age and induction of labor were independent risk factors for brachial plexus injury (odds ratio=1.599 and 81.862, respectively). Gestational weight gain (p=0.003) and neonatal birth weight (p=0.047) were also found as independent risk factors for shoulder dystocia.
CONCLUSION
Evidence from this study has shown that not only birth age or birth weight but also excessive weight gain by mother and induction of labor may increase the risk of clavicula fracture with brachial plexus palsy. Advanced maternal age, multiparity, and deliveries after 39 weeks seem to be risk factors for a clavicular fracture with a brachial plexus injury.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
目的
分析肩难产伴臂丛神经损伤新生儿锁骨骨折的危险因素，并探讨其发生率是否与局部特征有关。
方法
本研究为 2017 年 1 月至 2018 年 12 月期间进行的回顾性试验。对社区医院新生儿重症监护病房住院的锁骨骨折患儿进行回顾性分析。首先将锁骨骨折组分为两组，然后再分为两组亚组：伴/不伴肩难产和伴/不伴臂丛神经损伤的患儿。使用患者信息系统回顾围产期和新生儿的危险因素。记录任何其他神经或肌肉骨骼创伤。采用多变量 logistic 回归分析确定肩难产和臂丛神经损伤的独立预测因素。
结果
本研究共纳入 25 例（54%）肩难产和 12 例（26%）臂丛神经损伤的 46 例患儿。肩难产患儿的出生体重为 4164.2±412.7g，无肩难产患儿的出生体重为 3535.8±865.2g（p=0.003）。在 14 例（44%）接受引产且婴儿锁骨骨折的患者中，11 例（44%）存在肩难产（p=0.029）。14 例（66.7%）锁骨骨折且接受引产的婴儿中发现臂丛神经损伤（p=0.002）。回归分析显示，年龄和引产是臂丛神经损伤的独立危险因素（比值比分别为 1.599 和 81.862）。此外，妊娠体重增加（p=0.003）和新生儿出生体重（p=0.047）也是肩难产的独立危险因素。
结论
本研究结果表明，不仅是母亲的年龄或出生体重，还有母亲体重增加过多和引产，可能会增加伴臂丛神经损伤的锁骨骨折风险。高龄产妇、多胎妊娠和分娩超过 39 周似乎是伴臂丛神经损伤的锁骨骨折的危险因素。
证据等级
IV 级，治疗研究。
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