采用二维、三维超声及连续顺序追踪超声法对胎儿肢体畸形产前超声诊断分析

The ultrasound diagnosis of fetal limb deformity by using two dimensional,three dimensional ultrasound and continuous sequence tracing method

目的探讨采用二维、三维超声及连续顺序追踪超声法分析胎儿肢体畸形产前诊断的价值。方法采用连续顺序追踪超声法分析3059例产前胎儿的常规性二维、三维超声筛查结果,对其肢体的发育情况、异常情况和伴发畸形等进行重点分析,并对比分析产前超声资料和引产胎儿的尸检报告及其X线检查的结果,探讨肢体畸形的胎儿行产前超声的声像图的特点。结果 3059例胎儿行产前超声检查共检出肢体畸形15例,检出率为0.49%,其二维超声的主要表现是:手腕部的姿势异常3例,超声结果显示手腕部呈钩形;致死性骨发育不良3例,超声结果显示四肢短小;手指的姿势异常2例,超声结果显示四指未在同一个平面上;掌骨或手指缺如1例,超声结果中掌骨或指骨未显示;多指1例,超声结果显示手指缺如2例;前臂或手缺如1例,超声结果中掌骨、尺桡骨或指骨未显示;手指缺如1例,超声结果中指骨未显示;并指1例,超声结果显示手呈鸟嘴形。经引产检查发现采用产前超声诊断有2例漏诊,漏诊率为0.06%,其中包括:手指的姿势异常1例,部分手指缺如1例,胎儿的肢体畸形的发生率为0.56%。结论采用产前二维超声对严重肢体畸形的胎儿的检出及畸形的分类诊断具有重要的作用,选取合适的产前检查孕周、胎儿体位及联合采用连续顺序追踪超声法进行实时三维超声筛查,可有效提高肢体畸形的产前检出率。

Objective To analyze the diagnostic value of prenatal ultrasound in the diagnosis of fetal limb deformities by using two dimensional,three-dimensional ultrasound and continuous order tracking.Method 3059 cases of prenatal fetal were analyzed by using the method of routine and three-dimensional ultrasound.The results were analyzed and compared with the autopsy reports and X-ray examination.Result 3059 cases of fetal prenatal ultrasound detection work limb deformity in 15 cases,the detection rate was 0.49%,the main performance is that：the two-dimensional ultrasound wrist posture abnormalities in 3 cases which the results showed the ultrasonic hand has a hook shaped;lethal bone dysplasia in 3 cases,the results showed that ultrasonic limbs short;finger posture abnormalities in 2 cases,the ultrasound results showed that four not on the same plane;there were 1 case of metacarpal or fingers,the ultrasound results showed no multiple metacarpal or phalangeal;1 case of finger,the finger of ultrasound showed 2 cases;1 case of hand or forearm metacarpal,ulna or phalanges which did not show its results in the absence of ultrasound;fingers in 1 case,and did not show the ultrasound results;and that in 1 case,the results showed that the ultrasonic hand is beak shaped.After induction of labor inspection found by prenatal ultrasound in the diagnosis of 2 cases of misdiagnosis,missed diagnosis rate is 0.06%,including：fingers postural abnormalities in 1 case,the absence of part of the finger is in 1 case,fetal limb deformity occurrence rate was 0.56%.Conclusion Prenatal two dimensional ultrasound has played important role in the diagnosis and classification of severe limb malformations.The appropriate prenatal examination,fetal position and combined use of continuous sequential pursuit ultrasound can be used to carry out real-time three-dimensional ultrasound screening.