中孕期经三维超声胎儿脊髓圆锥定位 [中文引用][英文引用]

目的 探讨中孕期（20～26周）经三维超声定位胎儿脊髓圆锥及其对于隐性脊柱裂的诊断价值。方法 经三维骨骼模式成像分别对290例中孕期正常胎儿（正常组）和10例隐性脊柱裂胎儿（异常组）的脊髓圆锥进行定位，计数正常组脊髓圆锥末端水平所对应的腰椎椎体，观察胎儿脊髓圆锥的位置在中孕期正常胎儿的分布趋势及两组脊髓圆锥的位置差异。结果 282例中孕期胎儿经三维骨骼模式可清晰定位脊髓圆锥末端的位置，正常组的脊髓圆锥在孕20-21周可位于L3.5及以上水平，孕22周开始全部位于L3及以上水平，脊髓圆锥的位置与孕周之间的线性回归方程为：Y=0.179X+4.536（R=0.953，P<0.01）。异常组的10例均位于L3水平以下。结论 通过三维骨骼模式成像可以识别椎体的位置，以此进行脊髓圆锥的定位，隐性脊柱裂的胎儿脊髓圆锥的位置明显低于正常水平。脊髓圆锥的定位对于隐性脊柱裂的明确诊断有重要的临床价值。

Objective To investigate the value of the fetal conus medullaris positon and prenatal diagnosis of spina bifida occulta using three-dimensional ultrasound. Methods Two hundred and ninety normal fetuses in the second trimester (normal group) and 10 cases of spina bifida occulta (abnormal group) were enrolled. The conus medullaris position was assessed for each fetus with three-dimensional maximum mode. All normal cases were evaluated by counting the lumbar vertebra corresponding with the conus medullaris. The variation trend and difference were analyzed for normal and abnormal group. Result In two hundred and eighty-two normal cases, the conus medullaris positon were acquired clearly, all positioned at L3.5 or above L3.5, whereas in abnormal group, all positioned below L3 in 10 cases. The linear regression equation between conus medullaris position and gestation age was Y=0.179X+4.536（R=0.953,P<0.01）. Conclusions The conus medullaris position using three-dimensional ultrasound maximum mode is a valuable tool of the evaluation of normal fetus and spina bifida occulta. For spina bifida occulta, the position is obvious lower than normal case. It’s of great clinical value to accurately determine spina bifida occulta.