二维及实时三维超声在胎儿手畸形诊断中的应用  

The clinical application of two- and three-dimensional ultrasonography in the prenatal diagnosis of fetal hand deformity

作　　者：王家刚[1] 马雄涛[1] 张小林[1] 巨学明[2] 

机构地区：[1]广东省汕头市中山大学附属汕头医院超声科,515031 [2]四川省人民医院超声科

出　　处：《中华医学超声杂志（电子版）》2013年第10期26-30,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：广东省科技厅计划项目(2009B030801064)

摘　　要：目的总结不同类型胎儿手畸形产前二维及三维超声声像图特征,并分析产前超声漏诊胎儿手畸形的原因。方法采用连续顺序追踪超声法对11 854例胎儿行产前常规二维及三维超声系统筛查,重点观察胎儿手部发育、有无异常及伴发畸形,产前超声与引产胎儿尸检及X线检查结果对照,总结手畸形胎儿产前超声声像图特征。结果 11 854例胎儿产前超声检出手畸形59例(0.50%,59/11 854),手畸形胎儿产前二维超声表现:(1)手腕部姿势异常44例,声像图显示胎儿手腕部呈勾状;(2)手指完全缺如1例,声像图中胎儿指骨不显示;(3)掌骨及手指缺如2例,声像图中胎儿掌骨及指骨不显示;(4)手指姿势异常3例,声像图显示胎儿四指不在同一平面;(5)前臂及手缺如2例,声像图中胎儿尺桡骨、掌骨及指骨不显示;(6)并指1例,声像图显示胎儿手呈鸟嘴状;(7)多指2例,声像图显示胎儿手指为6指;(8)致死性骨发育不良5例,声像图显示胎儿四肢严重短小。引产胎儿检查发现产前超声漏诊手畸形8例(11.90%,8/67,包括部分手指缺如3例,手指姿势异常2例,多指2例,并指1例),胎儿手畸形发生率为0.57%(67/11 854)。结论产前二维超声在较严重手畸形胎儿的检出及手畸形分类诊断中有重要作用,选择合适的产前超声检查孕周、合适的胎儿体位、采用连续顺序追踪超声法结合实时三维超声细致扫查,可提高胎儿手畸形产前超声检出率。Objective To summarize the characteristics of fetal hand deformity in prenatal twoand three-dimensional u1trasonography.To analyze the causes of missed diagnosis of prenatal u1trasonography in detecting fetal hand deformity.Methods Systematic continuous sequence approach was performed with two-and three-dimensional u1trasonography in 11 854 cases to detect the fetal hand development,deformity and accompanied malformations.Prenatal sonographic features of fetal hand deformities（59 cases） were correlated with the morphology and X-ray characteristics of the delivered fetuses.Results Fifty-nine cases of fetal hand deformity were diagnosed out of 11 854 fetuses by prenatal u1trasonography： 44 cases of abnormal wrist posture,1 case of full-finger absence,2 cases of metacarpal and phalanx absence,3 cases of clinodactyly,2 cases of forearm and hand absence,1 case of syndacty,1 case of polydacty,5 cases of lethal bone dysplasia.The detection rate was 0.50%（59/11 854）.Eight cases were missed： 3 cases of partial finger absence,2 cases of clinodactyly,1 case of syndacty,and 2 cases of polydacty.The rate of missed diagnosis is 11.90%（8/67）.Abnormal wrist posture showed a hook-shaped hand in the wrist.Full-finger absence showed that one or multiple fingers were absent.Metacarpal and phalanx absence showed no fetal hands.Clinodactyly showed that four fingers were not in the same plane.Forearm and hand missing showed that ulna,metacarpal and phalangeal were absent.Syndacty showed a beak-like hand.Multi-finger indicated six fingers in one hand.Lethal bone dysplasia showed very short limbs.Conclusions Prenatal u1trasonography played an important role in detecting and diagnosing severe type of fetal hand deformity.The detection rate of fetal hand deformities can be greatly improved by appropriate use of the scan-time,fetal position,systematic continuous sequence approach and real three-dimensional u1trasonography.

关 键 词：超声检查 产前 胎儿 手畸形 先天性 

分 类 号：R445.1[医药卫生—影像医学与核医学] R714.5[医药卫生—诊断学]