三维及二维超声在胎儿脊髓圆锥定位中的应用价值

Application value of three-dimensional and two-dimensional ultrasound in positioning fetal conus medullaris

目的探讨三维及二维超声在胎儿脊髓圆锥定位中的应用价值。方法选取2017年1月至2019年1月在深圳市宝安区福永人民医院门诊接诊的正常孕19~37周的268例单胎孕妇为研究对象,采用三维及二维超声检查,检测不同孕周胎儿脊髓圆锥方位,并对其进行线性回归分析。结果 268例胎儿脊髓圆锥检查中,二维超声检查与三维超声VCI技术水平大致相同,Kappa值为1.0,在胎儿脊髓圆锥方位检测结果中表现出较好一致性;孕19~37周之间各孕周胎儿脊髓圆锥方位比较,差异无统计学意义(P>0.05);对比孕19周与20~37周之间各孕周胎儿脊髓圆锥方位,差异有统计学意义(P<0.05);比较孕20周与孕22周以上各孕周胎儿脊髓圆锥方位,差异有统计学意义(P<0.05);比较孕22~27周之间各孕周胎儿脊髓圆锥方位,差异无统计学意义(P>0.05);比较22~27周与孕28周以上各孕周胎儿脊髓圆锥方位,差异有统计学意义(P<0.05);比较孕28~29周与孕30周以上各孕周胎儿脊髓圆锥方位,差异有统计学意义(P<0.05);比较孕30~33周之间各孕周胎儿脊髓圆锥方位,差异无统计学意义(P>0.05);比较孕30~33周与孕34周以上各孕周胎儿脊髓圆锥方位,差异有统计学意义(P<0.05);比较孕34~36周之间各孕周胎儿脊髓圆锥方位差异无统计学意义(P>0.05);对比孕34~36周与孕37周胎儿脊髓圆锥方位,差异均有统计学意义(P<0.05);线性回归结果显示,孕周与胎儿脊髓圆锥方位呈正相关(r=0.807,P<0.05)。结论三维及二维超声检查对胎儿脊髓圆锥定位效果满意,二维超声检查与三维超声VCI技术均清晰显示出胎儿脊髓圆锥方位和形态,有助于准确识别其位置,极大提高了判断胎儿脊髓圆锥方位的准确性,临床诊断价值高。

Objective To explore the application value of three-dimensional and two-dimensional ultrasound in positioning fetal conus medullaris. Methods A total of 268 pregnant women with singleton with 19 to 37 weeks of normal pregnancy from January 2017 to January 2019 in Fuyong People's Hospital of Bao'an District of Shenzhen were selected as subjects, and three-dimensional and two-dimensional ultrasound examinations were used to localize the fetal conus medullaris in different gestational weeks. Linear regression analysis was performed. Results Among the 268 cases, the two-dimensional ultrasonography was similar to three-dimensional ultrasonography in volume contrast imaging (VCI) technique, and the Kappa value was 1.0, which showed good consistency in the results of positioning fetal conus medullaris. There were no statistically significant difference in the position of fetal conus medullaris between the 19 and 37 weeks of pregnancy (P>0.05), but with significant difference between 19 weeks and 20 to 37 weeks of pregnancy (P< 0.05), as well as between 20 weeks of pregnancy and 22 weeks of pregnancy (P<0.05). There were no statistically significant difference among 22 to 27 weeks of pregnancy (P>0.05), but with statistically significant difference between 22 to 27 weeks of pregnancy and more than 28 weeks (P<0.05), as well as between 28 to 29 weeks of pregnancy and 30 weeks of pregnancy (P<0.05). There were no statistically significant difference among 30 to 33 weeks of gestation (P> 0.05), but with statistically significant difference between 30 to 33 weeks of gestation and more than 34 weeks of gestation (P<0.05). There were no statistically significant difference among 34 to 36 weeks of pregnancy (P>0.05), but with statistically significant difference between 34 to 36 weeks of pregnancy and 37 weeks of pregnancy (P<0.05). Linear regression results showed a positive correlation between gestational age and fetal spinal cone position (r=0.807, P< 0.05). Conclusion Three-dimensional and two-dimensional ultrasound examinations are satisfactory for the fetal spinal conical positioning. The two-dimensional ultrasonography and three-dimensional ultrasound VCI technology clearly show the orientation and shape of the fetal spinal cone, which helps to accurately identify its position and greatly improve the fetal spinal cone. The accuracy of the orientation is high in clinical diagnosis.