2015 , Vol. 12 >Issue 02: 116 - 121
DOI: https://doi.org/10.3877/cma.j.issn.1672-6448.2015.02.007
早孕期胎儿肢体规范化检查方法及应用研究
收稿日期: 2013-12-10
网络出版日期: 2015-02-01
基金资助
国家自然科学基金面上项目(81270707); 国家自然科学基金青年基金项目(61101026); 2011年深圳市科技计划项目(201101013)
Study on the methodology and feasibility of an anatomic survey of fetal limbs in the first trimester
Received date: 2013-12-10
Online published: 2015-02-01
探讨连续顺序追踪超声法在11~13+6周早孕期胎儿肢体规范化检查中的应用及声像图特征。
选取应用连续顺序追踪超声法对2011年6月至2012年8月在深圳市妇幼保健院行早孕期超声检查的533例正常胎儿（宫内胎儿组，孕11~13+6周）及6例早孕期流产或引产胎儿（产后胎儿组，无肢体畸形，孕12~13+6周，胎儿标本浸入水盆中检查）的肢体行双上肢长轴切面（多位于胸廓前方）及双下肢长轴切面扫查，对不能在同一切面显示整条肢体长轴切面的胎儿，连续观察并显示胎儿肢体三节段（近段、中段及远段），分析两组胎儿肢体解剖结构的超声声像图特征。
宫内胎儿组533例胎儿经腹部超声双上肢长轴切面可依次清晰显示双侧上臂及其内肱骨、前臂及其内尺（桡骨）、双手；双下肢长轴切面可依次清晰显示双侧大腿及其内股骨、小腿及其内胫（腓骨）、双足（足趾不能显示）；手足的长轴切面表现为以初级骨化中心的条状强回声为中心，周围为稍低回声的软组织包绕；手指及足趾的显示多表现为指端皮肤或软组织的点状稍强回声。完成胎儿肢体检查的时间为36~189 s，平均（98.6±37.4）s。产后胎儿组6例，超声清晰显示肢体长骨（肱骨、股骨、胫骨、腓骨、尺骨、桡骨、掌骨、跖骨）骨化中心及软组织。其中3例大于13孕周的胎儿除第五指中节指骨外产前超声能稳定显示手指骨化中心；而3例小于13孕周的胎儿足趾骨化中心完全不显示。
应用连续顺序追踪超声法可在较短时间内完成11~13+6周早孕期胎儿肢体检查，产前超声不能完全显示胎儿部分手指和足趾。早孕期胎儿规范化检查的推广和普及对减少漏误诊，减少肢体畸形胎儿出生有重要意义。
廖伊梅 , 李胜利 , 文华轩 . 早孕期胎儿肢体规范化检查方法及应用研究[J]. 中华医学超声杂志（电子版）, 2015 , 12(02) : 116 -121 . DOI: 10.3877/cma.j.issn.1672-6448.2015.02.007
To investigate the methodology and feasibility of an anatomic survey of fetal limbs in the first trimester.
In this study, 533 normal fetus and 6 fetal corpse without limb abnormalities form June 2011 to August 2012 underwent an anatomic survey on the limbs in our consultation center. The limbs were scanned using a systematic continuous sequence approach: (1) Displaying upper arm and humerus, forearms and radius/ulna, hands in proximal to distal direction. (2) The thigh and femur, crus and tibia/fibula, feet was attempted from the sagittal section of each structure. (3) If the whole limb couldn′t be visualized in a section then the three segments will be demonstrated respectively. The position and movement also should be observed during the scan. Data were collected regarding gestation age, examining time and the structures.
The limbs except toes of 533 normal fetus were clearly observed, which was completely unaffected by gestational age, with the mean time of scanning is 98.6±37.4 s (rang: 36-189 s). The structures (including upper arms and humerus, forearms ,radius and ulna, hands, thigh and femur, crus and tibia, fibula, feet) of fetal limbs were clearly observed on the 6 fetal corpse, but the ossification center of fingers were steadily visualized until 13 weeks and toes after 13 weeks.
Scanning fetal limbs in the first trimester were feasible by a systematic continuous sequence approach in a short period of time.
Key words： Ultrasonography, prenatal; Fetal; Limbs; First trimester
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