胎儿脊柱冠状椎体裂的超声诊断及临床转归观察  

Ultrasound evaluation and outcome analysis of fetal coronal cleft vertebrae

作　　者：张小林 朱兆领 王睿丽 高园 刘冰冰 郭梁洁 ZHANG Xiaolin;ZHU Zhaoling;WANG Ruili;GAO Yuan;LIU Bingbing;GUO Liangjie(Department of Ultrasound,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China;Institute of Genetics,Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]郑州大学人民医院河南省人民医院超声科,河南郑州450003 [2]郑州大学人民医院河南省人民医院遗传研究所,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2023年第11期1157-1160,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220042)。

摘　　要：目的观察胎儿脊柱冠状椎体裂的超声声像表现,探讨其临床转归。方法2018年1月—2021年12月河南省人民医院孕中期超声检查诊断胎儿脊柱冠状椎体裂的单胎妊娠孕妇107例,观察二维及三维超声声像资料,遗传学检查结果,终止妊娠情况。未终止妊娠者孕晚期行超声复查,并随访至产后1年,观察冠状椎体裂愈合情况。结果(1)107例胎儿二维及三维超声脊柱矢状切面见纵行、横切面上横形无回声裂隙将椎体分为前后2部分。单椎体受累42例(39.3%),多椎体受累65例(60.7%);胸椎受累63例(58.9%),腰椎受累25例(23.4%),颈椎受累3例(2.8%),颈椎及胸椎同时受累2例(1.9%),胸椎及腰椎同时受累14例(13.1%);孤立性冠状椎体裂69例(64.5%),非孤立性冠状椎体裂38例(35.5%)。38例非孤立性冠状椎体裂中15例合并前半椎体矢状裂,二维超声仅可见冠状裂隙,三维超声冠状面及横切面见前半椎体矢状裂。(2)56例行无创DNA检测,均提示低风险;30例行羊水穿刺,检出染色体异常6例(孤立性冠状椎体裂、非孤立性冠状椎体裂各3例),均为胸椎受累。(3)30例终止妊娠者中行遗传学检查25例,其中染色体异常6例。77例继续妊娠者中10例失访,17例孕晚期未复查超声,50例孕25~37(32.1±3.8)周复查超声,结果显示25例椎体冠状裂消失,20例累及椎体无变化但裂隙变窄呈细线样或点状,5例累及椎体及裂隙较前无明显变化,其中2例合并半椎体畸形、脊柱侧凸。(4)67例随访至出生后1年,25例孕晚期超声提示冠状裂消失者未见脊柱侧凸及其他异常;余42例出生1年内行脊柱X线或MRI检查,40例冠状椎体裂消失,1例L1及L3椎体冠状椎体裂合并半椎体畸形、脊柱侧凸,1例多个椎体冠状裂合并半椎体畸形、脊柱侧凸。结论冠状椎体裂好发于胸、腰椎,多数可于孕晚期及出生后自愈,合并半椎体畸形、脊柱侧凸者不易愈合,产前行二维联合三维超声对评估胎儿�Objective To observe the ultrasonographic findings of fetuses with coronal cleft vertebrae,and to explore their prognosis.Methods Totally 107 singleton pregnant women in the second trimester received ultrasound to observe the fetal coronal cleft vertebrae in Henan Provincial People's Hospital from January 2018 to December 2021.They were observed 2D and 3D ultrasound data,genetic examination results,and termination of pregnancy.Those continuing pregnancy were reexamined by ultrasound in the third trimester of pregnancy and the fetuses were followed up to 1 year after birth to observe the healing of coronal cleft vertebrae.Results(1)The results of 2D and 3D ultrasound showed that the transverse anechoic clefts in sagittal and longitudinal sections of the spine in 107 fetuses divided the vertebral body into anterior and posterior parts,which involved single vertebral body in 42 cases(39.3%)and multiple vertebral bodies in 65cases(60.7%);involved thoracic spine in 63 cases(58.9%),lumbar spine in 25 cases(23.4%),cervical spine in 3cases(2.8%),cervical and thoracic spine in 2 cases(1.9%),and thoracic and lumbar spine in 14 cases(13.1%).There were 69 cases(64.5%)of isolated coronal cleft vertebrae and 38 cases(35.5%)of non-isolated coronal cleft vertebrae.Among 38 cases of non-isolated coronal cleft vertebrae,15 cases were found anterior hemivertebral sagittal clefts in coronal and transverse views by 3D ultrasound,but 2D ultrasound only found coronal clefts.(2)The non-invasive DNA testing in 56 cases suggested low risk.Amniocentesis was performed in 30 cases,revealing chromosomal abnormalities in 6 cases(isolated coronal cleft vertebrae in 3 and non-isolated coronal cleft vertebrae in 3),all of which were involved in thoracic vertebrae.(3)Thirty patients were terminated pregnancy,among whom 25 received genetic tests,revealing chromosomal abnormalities in 6.Among 77 pregnant women who continued pregnancy,10 were lost to follow-up,17 received no ultrasound examination in the third trimester,and 50 received ultrasound exa

关 键 词：胎儿冠状椎体裂 产前超声检查 临床转归 

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]