胎儿开放性脊柱裂和闭合性脊柱裂的超声鉴别诊断

The value of prenatal ultrasonic diagnosis of fetal open and closed spina bifida

目的探讨超声诊断胎儿脊柱裂的价值及鉴别诊断开放性脊柱裂和闭合性脊柱裂的实用方法。方法回顾性分析2010年1月—2014年12月在复旦大学附属妇产科医院经过超声诊断的63例脊柱裂,包括中孕期（20.1~23.6周）超声筛查67 618例孕妇中所诊断的11例和外院转诊至我院超声诊断的52例（13.5~32.6周）。结果孕中期（20.1~23.6周）脊柱裂发生率为0.016%。开放性脊柱裂43例（占68.3%）,其中合并Arnold-ChiariⅡ型异常39例,无合并Arnold-ChiariⅡ型异常的4例。闭合性脊柱裂20例（占31.7%）,后颅窝池消失、双侧脑室扩张和小脑横径〈5%在开放性脊柱裂和闭合性脊柱裂中的差异有显著统计学意义（P〈0.01）。结论产前超声诊断胎儿脊柱裂具有重要临床价值。根据超声图像判断是否伴有胎儿颅脑的改变可以区分开放性脊柱裂和闭合性脊柱裂。

Objective To evaluate the value of ultrasonic diagnosis of spina bifida and identify sonographic criteria useful for differentiating open from closed spina bifida in utero. Methods We retrospectively analyzed 67 618 cases pregnant women（20.1-23.6 weeks）by midtrimester screening ultrasound diagnosis in Obstetrics and Gynecology Hospital of Fudan University,from Jan.2010 to Dec.2014.Among them11 cases of spina bifida were diagnosed by ultrasound.Another 52 cases（13.5-36.3 weeks）transferred from other hospitals were also diagnosed spina bifida by ultrasound.A total of 63 cases were enrolled. Results In this study,the rate of spina bifida was 1.6 per 10000 fetuses.Forty-three cases（68.3%）were diagnosed of open spina bifida,including 39 cases with Arnold-Chiari type Ⅱ and 4 cases without Arnold-Chiari type Ⅱ.Twenty cases（31.7%）were diagnosed of closed spina bifida.Obliteration cisterna magna,ventriculomegaly and cerebellum length5% had significant differences in open and closed spina bifida（P0.01）.In closed spina bifida,associated anomalies included agenesis of corpus callosum with under cerebellar vermis,diastematomyelia,tethered cord with spinal canal lipoma,hemivertebra and spinal canal enlargement.Conclusions Ultrasound diagnosis has great value in screening spina bifida.The differentiation between open and closed defects is best shown by the sonographic demonstration of abnormal or normal cranial anatomy.