腰骶关节两线相交法判定胎儿脊髓圆锥位置  

Two-line intersection method of lumbosacral junction in localization of fetal conus medullaris

作　　者：翟晶 蔡爱露[1] 董岚 蔡畅 李冬梅[1] ZHAI Jing;CAI Ailu;DONG Lan;CAI Chang;LI Dongmei(Department of Ultrasound,Shengjing Hospital of China Medical University, Shenyang 110004,China;Department of Ultrasound,Dalian Maternal and Child Health Hospital,Dalian 116030,China)

机构地区：[1]中国医科大学附属盛京医院超声科,辽宁沈阳110004 [2]大连市妇幼保健院超声科,辽宁大连116030

出　　处：《中国介入影像与治疗学》2018年第12期739-742,共4页Chinese Journal of Interventional Imaging and Therapy

基　　金："十二五"国家科技支撑计划项目(2014BAI06B05)

摘　　要：目的探讨腰骶关节两线相交法定位胎儿脊髓圆锥的位置的可行性。方法选取20～38周正常胎儿581胎,以腰骶关节两线相交法识别S1椎体,定位脊髓圆锥相应椎体水平,观察各孕周脊髓圆锥位置分布情况;随机选取101胎不同孕周胎儿观察不同医师间及腰骶关节两线相交法与三维成像定位结果的一致性。结果 2名医师采用腰骶关节两线相交法定位脊髓圆锥的一致性好(Kappa=0.94);腰骶关节两线相交定位与三维成像定位一致性好(Kappa=0.92)。530胎腰骶关节两线相交法可识别S1椎体并定位脊髓圆锥,脊髓圆锥对应的椎体水平范围为L1～L4,其中对应L1椎体、L1-2椎间隙、L2椎体、L_(2-3)椎间隙、L3椎体、L_(3-4)椎间隙和L4椎体分别占4.72%(25/530)、8.68%(46/530)、51.32%(272/530)、19.62%(104/530)、11.89%(63/530)、2.26%(12/530)和1.51%(8/530);脊髓圆锥随孕周呈逐渐上升趋势;≥23孕周时,全部位于L3椎体及以上;≥32孕周时,98.38%(182/185)达L2-3椎间隙及以上,≥37孕周时,94.83%(55/58)上升至L2椎体及以上。结论通过腰骶关节两线相交法可识别S1椎体,进而准确定位脊髓圆锥水平,可用于快速判断脊髓圆锥位置。Objective To explore the feasibility of two-line intersection method of lumbosacral junction in localization of fetal conus medullaris.Methods A total of 581 normal fetuses with 20-38 weeks of gestational age were included.Two-line intersection method of lumbosacral junction was used to identify S1 vertebra and then counted upward to localize the fetal conus medullaris at the level of vertebral body.The distribution of conus medullaris position in each gestational age was observed.Then 101 fetuses in different gestational age were randomly selected to analyze the consistency of localization results within two operators and with three-dimensional imaging.Results The consistency of localization within two operators and two methods were both good(Kappa=0.94,0.92).Two-line intersection method of lumbosacral junction could easily and clearly locate the conus medullaris in 530 fetuses,and the distribution of conus medullaris was L1(25/530,4.72%),L 1-2 disc(46/530,8.68%),L2(272/530,51.32%),L 2-3 disc(104/530,19.62%),L3(63/530,11.89%),L 3-4 disc(12/530,2.26%)and L4(8/530,1.51%).Furthermore,when gestational age was≥23 weeks,all conus medullaris located at or above L3 level;when gestational age was≥32 weeks,98.38%(182/185)conus medullaris was at or above L 2-3 level;when gestational age was≥37 weeks,94.83%(55/58)conus medullaris was at or above L2 level.Conclusion Two-line intersection method of lumbosacral junction could be used to identify S1 and locate the fetal conus medullaris accurately,therefore could be used to determine the position of conus medullaris quickly and conveniently.

关 键 词：腰骶关节 脊髓圆锥 胎儿 超声检查 产前 

分 类 号：R714.5[医药卫生—妇产科学] R445.1[医药卫生—临床医学]