脊髓圆锥定位在产前超声诊断脊柱裂的应用研究

Application of Conus Medullaris Localization in the Prenatal Ultrasound Diagnosis of Fetal Spina Bifida

目的探讨脊髓圆锥定位在产前超声诊断脊柱裂的作用。方法收集我院2013年12月—2017年4月产前超声检查诊断为脊柱裂的14例病例,回顾性分析其颅脑、脊髓圆锥位置、脊柱及其背侧皮肤、包块等情况,并与经引产或分娩诊断为脊柱裂的结果进行对比。结果产前超声诊断为脊柱裂14例,包括4例开放性脊柱裂和10例闭合性脊柱裂,全部经引产或分娩后证实。其中,4例开放性脊柱裂均有典型颅脑声像改变、脊髓圆锥低置和骶尾部包块,三种超声征象检出率的差异性不具有统计学意义(P=1.000);10例闭合性脊柱裂均无典型颅脑声像改变,10例见脊髓圆锥低置,6例见骶尾部包块,三种超声征象中脊髓圆锥低置与典型颅脑征象、骶尾部包块检出率的差异性具有统计学意义(P<0.05)。结论脊髓圆锥低置对比典型颅脑声像改变及骶尾部包块超声征象在诊断胎儿开放性脊柱裂中无明显优势,但在诊断闭合性脊柱裂上有明显的优势,对早期发现和诊断胎儿闭合性脊柱裂有重要的作用。

Objective To investigate the role of fetal conus medullaris localization in prenatal ultrasound diagnosis of spina bifida. Methods Collected a total of 14 cases of spina bifida diagnosed by prenatal ultrasonography in our hospital from December 2013 to April 2017. Retrospectively analyzed the brain,conus medullaris position,spinal cord,dorsal skin and mass. Compared the results of spina bifida diagnosed after induction or delivery. Results The 14 cases of spina bifida diagnosed by prenatal ultrasound included 4 cases of open spina bifida and 10 cases of closed spina bifida,all confirmed after induction or delivery. Among them,there were craniocerebral acoustic changes,low conus medullaris and sacrococcygeal mass in the 4 cases of open spina bifida. There was no statistically difference in the detection rate of three kinds of ultrasonic signs( P = 1. 000). There was no typical craniocerebral acoustic changes in the 10 cases of closed spina bifida,of which 10 cases had low conus medullaris and 6 cases had sacrococcygeal mass. There was statistically difference in the detection rate of three kinds of ultrasonic signs( P < 0. 05). Conclusion There is no obvious advantage in low conus medullaris compared with typical craniocerebral acoustic changes and sacrococcygeal mass ultrasound signs. It plays an important role in the early detection and diagnosis of fetal closed spina bifida.