中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2013年
10期
26-30
,共5页
王家刚%马雄涛%张小林%巨学明
王傢剛%馬雄濤%張小林%巨學明
왕가강%마웅도%장소림%거학명
超声检查,产前%胎儿%手畸形,先天性
超聲檢查,產前%胎兒%手畸形,先天性
초성검사,산전%태인%수기형,선천성
Ultrasonography,prenatal%Fetus%Hand deformities,congenital
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11854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11854例胎儿产前超声检出手畸形59例（0.50%，59/11854），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%（67/11854）。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。
目的總結不同類型胎兒手畸形產前二維及三維超聲聲像圖特徵，併分析產前超聲漏診胎兒手畸形的原因。方法採用連續順序追蹤超聲法對11854例胎兒行產前常規二維及三維超聲繫統篩查，重點觀察胎兒手部髮育、有無異常及伴髮畸形，產前超聲與引產胎兒尸檢及X線檢查結果對照，總結手畸形胎兒產前超聲聲像圖特徵。結果11854例胎兒產前超聲檢齣手畸形59例（0.50%，59/11854），手畸形胎兒產前二維超聲錶現：（1）手腕部姿勢異常44例，聲像圖顯示胎兒手腕部呈勾狀；（2）手指完全缺如1例，聲像圖中胎兒指骨不顯示；（3）掌骨及手指缺如2例，聲像圖中胎兒掌骨及指骨不顯示；（4）手指姿勢異常3例，聲像圖顯示胎兒四指不在同一平麵；（5）前臂及手缺如2例，聲像圖中胎兒呎橈骨、掌骨及指骨不顯示；（6）併指1例，聲像圖顯示胎兒手呈鳥嘴狀；（7）多指2例，聲像圖顯示胎兒手指為6指；（8）緻死性骨髮育不良5例，聲像圖顯示胎兒四肢嚴重短小。引產胎兒檢查髮現產前超聲漏診手畸形8例（11.90%，8/67，包括部分手指缺如3例，手指姿勢異常2例，多指2例，併指1例），胎兒手畸形髮生率為0.57%（67/11854）。結論產前二維超聲在較嚴重手畸形胎兒的檢齣及手畸形分類診斷中有重要作用，選擇閤適的產前超聲檢查孕週、閤適的胎兒體位、採用連續順序追蹤超聲法結閤實時三維超聲細緻掃查，可提高胎兒手畸形產前超聲檢齣率。
목적총결불동류형태인수기형산전이유급삼유초성성상도특정，병분석산전초성루진태인수기형적원인。방법채용련속순서추종초성법대11854례태인행산전상규이유급삼유초성계통사사，중점관찰태인수부발육、유무이상급반발기형，산전초성여인산태인시검급X선검사결과대조，총결수기형태인산전초성성상도특정。결과11854례태인산전초성검출수기형59례（0.50%，59/11854），수기형태인산전이유초성표현：（1）수완부자세이상44례，성상도현시태인수완부정구상；（2）수지완전결여1례，성상도중태인지골불현시；（3）장골급수지결여2례，성상도중태인장골급지골불현시；（4）수지자세이상3례，성상도현시태인사지불재동일평면；（5）전비급수결여2례，성상도중태인척뇨골、장골급지골불현시；（6）병지1례，성상도현시태인수정조취상；（7）다지2례，성상도현시태인수지위6지；（8）치사성골발육불량5례，성상도현시태인사지엄중단소。인산태인검사발현산전초성루진수기형8례（11.90%，8/67，포괄부분수지결여3례，수지자세이상2례，다지2례，병지1례），태인수기형발생솔위0.57%（67/11854）。결론산전이유초성재교엄중수기형태인적검출급수기형분류진단중유중요작용，선택합괄적산전초성검사잉주、합괄적태인체위、채용련속순서추종초성법결합실시삼유초성세치소사，가제고태인수기형산전초성검출솔。
Objective To summarize the characteristics of fetal hand deformity in prenatal two-and 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-ifnger 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 ifnger 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 ifngers were absent. Metacarpal and phalanx absence showed no fetal hands. Clinodactyly showed that four ifngers 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-ifnger indicated six ifngers 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.
