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目的分析合并骨折的早产儿代谢性骨病患儿临床资料及随访情况,为其防治提供指导依据。方法对2009年11月至2013年12月我院新生儿重症监护室确诊合并骨折的早产儿代谢性骨病患儿临床资料进行回顾性分析,包括一般资料、临床表现、辅助检查、治疗、转归及随访情况。结果共确诊5例患儿,均为男性,出生胎龄<32周,出生体重≤1000 g,3例为小于胎龄儿,3例母亲重度子痫前期或重度子痫。5例均有反复喂养不耐受,胃肠外营养时间≥30天,3例呼吸机辅助通气时间≥20天。发现骨折时间分别为:生后6~7周3例,生后11周1例,生后17周1例;4例表现局部肢体肿胀。X线显示骨折形成,血钙无异常,碱性磷酸酶高于正常,4例血磷低于正常。2例绷带固定,1例双下肢皮牵引、双下肢悬吊位、小儿髋关节吊带固定治疗,1例患侧上肢功能位制动,1例未予特殊处理。随访患儿骨折均愈合良好,肢体对称、活动无明显异常。结论合并骨折的早产儿代谢性骨病多见于男性超低出生体重儿,好发于校正胎龄36~40周,与钙磷储备少、生后早期钙磷摄入不足及应用类固醇激素等药物有关,近期预后良好。
Objective To analyze the clinical data and follow-up of children with metabolic bone disease in premature infants with fracture, and provide guidance for their prevention and treatment. Methods The clinical data of children with metabolic osteoporosis in our hospital from November 2009 to December 2013 were retrospectively analyzed, including general information, clinical manifestations, auxiliary examination, treatment, Attributed to follow-up situation. Results A total of 5 children were diagnosed. All of them were male. The gestational age was less than 32 weeks. The birth weight was less than or equal to 1000 g. Three patients were less than gestational age and three had severe preeclampsia or severe eclampsia. 5 cases were repeatedly intolerant, parenteral nutrition ≥ 30 days, 3 cases of ventilator-assisted ventilation ≥ 20 days. The time of fracture was found to be 3 cases 6 to 7 weeks after birth, 1 case 11 weeks after birth, and 1 case 17 weeks after birth. In 4 cases, the swelling of local limbs was observed. X-ray showed fracture formation, no abnormal serum calcium, alkaline phosphatase than normal, 4 cases of serum phosphorus lower than normal. 2 cases of bandage fixation, 1 case of bilateral lower extremity skin traction, double lower extremity suspension, pediatric hip strap fixation, 1 case of upper limb immobilization, and 1 case without special treatment. All the fractures healed well, the limbs were symmetrical, and there was no obvious abnormal activity. Conclusions Metabolic bone disease in premature infants with combined fractures is more common in males with LBW, occurring at corrected gestational age of 36-40 weeks with less reserves of calcium and phosphorus, inadequate intake of calcium and phosphorus in the early postnatal period and the use of drugs such as steroid hormones Related, the recent good prognosis.