中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
Chinese Journal of Perinatal Medicine
2015年
10期
770-773
,共4页
何韶铮%吕国荣%阮俊贤%吴家祥%刘云萍
何韶錚%呂國榮%阮俊賢%吳傢祥%劉雲萍
하소쟁%려국영%원준현%오가상%류운평
脊髓%超声检查,产前%骶骨
脊髓%超聲檢查,產前%骶骨
척수%초성검사,산전%저골
Spinal cord%Ultrasonography,prenatal%Sacrum
目的 探讨脊髓圆锥末端至骶骨末端距离的正常值及临床应用价值. 方法 2013年6月1日至2014年9月30日,在福建医科大学附属第二医院就诊的孕妇中,纳入超声孕龄与实际孕龄相符、排除胎儿畸形、分娩后随访新生儿无异常的单胎妊娠孕妇550例.产前超声测量胎儿双顶径、股骨长、头围、腹围,并测量脊髓圆锥末端至骶骨末端距离.根据孕周分组,计算各孕周的平均值.抽取50例孕妇进行质量控制,比较甲、乙2名医师测量结果的一致性,以及甲医师间隔半小时对同一例孕妇测量结果的一致性.计算胎儿脊髓圆锥末端至骶骨末端距离与孕周、双顶径、股骨长、头围、腹围的回归方程.采用组内相关系数(intraclass correlation coefficient,ICC)和Bland-Altman分析图分析重复性. 结果 550例胎儿中,51 8例(94.2％)成功测量到脊髓圆锥末端至骶骨末端距离.随孕周增加,胎儿脊髓圆锥末端至骶骨末端的距离逐渐增加,妊娠＞14～≤15周(n=17)为(10.0±3.3) mm,妊娠＞20～≤21周(n=18)为(27.7±3.8) mm,妊娠＞ 26～≤27周(n=8)为(41.5±2.4)mm,妊娠＞32～≤33周(n=17)为(54.7±3.0)mm,妊娠＞41～≤42周(n=6)为(71.9±2.7) mm.胎儿脊髓圆锥末端至骶骨末端距离(mm)的回归方程分别为:股骨长(mm)×1.04-8.71、腹围(mm)×0.23-10.11、头围(mm)×0.28-18.10、双顶径(mm)×0.90-17.65、孕周(周)×2.34-20.94(相关系数分别为0.990、0.985、0.978、0.974和0.973,P值均＜0.01).甲、乙医师测量数据的ICC和甲医师测量2组数据的ICC分别为0.984 (95％CI:0.972～0.991)和0.992 (95％CI: 0.985～0.995),95％一致性界限分别为:-1.8～3.5 mm和-4.3～2.1 mm.Bland-Altman分析图可见大部分测量值位于95％一致性界限内,提示一致性较好. 结论 超声测量的胎儿脊髓圆锥末端至骶骨末端距离与股骨长等因素呈正相关,可作为评估脊髓圆锥末端位置的定量指标.
目的 探討脊髓圓錐末耑至骶骨末耑距離的正常值及臨床應用價值. 方法 2013年6月1日至2014年9月30日,在福建醫科大學附屬第二醫院就診的孕婦中,納入超聲孕齡與實際孕齡相符、排除胎兒畸形、分娩後隨訪新生兒無異常的單胎妊娠孕婦550例.產前超聲測量胎兒雙頂徑、股骨長、頭圍、腹圍,併測量脊髓圓錐末耑至骶骨末耑距離.根據孕週分組,計算各孕週的平均值.抽取50例孕婦進行質量控製,比較甲、乙2名醫師測量結果的一緻性,以及甲醫師間隔半小時對同一例孕婦測量結果的一緻性.計算胎兒脊髓圓錐末耑至骶骨末耑距離與孕週、雙頂徑、股骨長、頭圍、腹圍的迴歸方程.採用組內相關繫數(intraclass correlation coefficient,ICC)和Bland-Altman分析圖分析重複性. 結果 550例胎兒中,51 8例(94.2％)成功測量到脊髓圓錐末耑至骶骨末耑距離.隨孕週增加,胎兒脊髓圓錐末耑至骶骨末耑的距離逐漸增加,妊娠＞14～≤15週(n=17)為(10.0±3.3) mm,妊娠＞20～≤21週(n=18)為(27.7±3.8) mm,妊娠＞ 26～≤27週(n=8)為(41.5±2.4)mm,妊娠＞32～≤33週(n=17)為(54.7±3.0)mm,妊娠＞41～≤42週(n=6)為(71.9±2.7) mm.胎兒脊髓圓錐末耑至骶骨末耑距離(mm)的迴歸方程分彆為:股骨長(mm)×1.04-8.71、腹圍(mm)×0.23-10.11、頭圍(mm)×0.28-18.10、雙頂徑(mm)×0.90-17.65、孕週(週)×2.34-20.94(相關繫數分彆為0.990、0.985、0.978、0.974和0.973,P值均＜0.01).甲、乙醫師測量數據的ICC和甲醫師測量2組數據的ICC分彆為0.984 (95％CI:0.972～0.991)和0.992 (95％CI: 0.985～0.995),95％一緻性界限分彆為:-1.8～3.5 mm和-4.3～2.1 mm.Bland-Altman分析圖可見大部分測量值位于95％一緻性界限內,提示一緻性較好. 結論 超聲測量的胎兒脊髓圓錐末耑至骶骨末耑距離與股骨長等因素呈正相關,可作為評估脊髓圓錐末耑位置的定量指標.
목적 탐토척수원추말단지저골말단거리적정상치급림상응용개치. 방법 2013년6월1일지2014년9월30일,재복건의과대학부속제이의원취진적잉부중,납입초성잉령여실제잉령상부、배제태인기형、분면후수방신생인무이상적단태임신잉부550례.산전초성측량태인쌍정경、고골장、두위、복위,병측량척수원추말단지저골말단거리.근거잉주분조,계산각잉주적평균치.추취50례잉부진행질량공제,비교갑、을2명의사측량결과적일치성,이급갑의사간격반소시대동일례잉부측량결과적일치성.계산태인척수원추말단지저골말단거리여잉주、쌍정경、고골장、두위、복위적회귀방정.채용조내상관계수(intraclass correlation coefficient,ICC)화Bland-Altman분석도분석중복성. 결과 550례태인중,51 8례(94.2％)성공측량도척수원추말단지저골말단거리.수잉주증가,태인척수원추말단지저골말단적거리축점증가,임신＞14～≤15주(n=17)위(10.0±3.3) mm,임신＞20～≤21주(n=18)위(27.7±3.8) mm,임신＞ 26～≤27주(n=8)위(41.5±2.4)mm,임신＞32～≤33주(n=17)위(54.7±3.0)mm,임신＞41～≤42주(n=6)위(71.9±2.7) mm.태인척수원추말단지저골말단거리(mm)적회귀방정분별위:고골장(mm)×1.04-8.71、복위(mm)×0.23-10.11、두위(mm)×0.28-18.10、쌍정경(mm)×0.90-17.65、잉주(주)×2.34-20.94(상관계수분별위0.990、0.985、0.978、0.974화0.973,P치균＜0.01).갑、을의사측량수거적ICC화갑의사측량2조수거적ICC분별위0.984 (95％CI:0.972～0.991)화0.992 (95％CI: 0.985～0.995),95％일치성계한분별위:-1.8～3.5 mm화-4.3～2.1 mm.Bland-Altman분석도가견대부분측량치위우95％일치성계한내,제시일치성교호. 결론 초성측량적태인척수원추말단지저골말단거리여고골장등인소정정상관,가작위평고척수원추말단위치적정량지표.
Objective To determine the normal position of the fetal conus medullaris and assess its clinical significance.Methods A total of 550 singleton pregnant women who were examined by fetal ultrasonography in the Department of Ultrasound at the Second Hospital of Fujian Medical University from June 1, 2013 to September 31, 2014 were included.Inclusion criteria were pregnancies with regular menstruation cycle and known last menstrual period, gestational age (GA) confirmed by ultrasonographic examinations, and neonate abnormality excluded by pediatrician after born.Routine obstetric ultrasound examinations were performed to measure the biparietal diameter (BPD), femur length (FL), head circumference (HC) and abdominal circumference (AC).The conus distance (CD) was determined by measuring the distance between the distal end of the conus medullaris and the caudal end of the last vertebra.The average value was calculated for each group according to GA.Fifty normal fetuses were randomly selected for quality control.For inter-observer reliability assessment, the same data were collected and analyzed by two different operators.For intra-observer reliability assessment, the data were collected and analyzed twice by the same operator with an interval of half an hour.Linear regression correlation analysis was performed to analyze the relationship between CD and GA, BPD, FL, HC and AC.Intraclass correlation coefficient (ICC) and Bland-Altman analysis were used to analyze the repeatability of the analysis.Results In 518 (94.2％) of 550 fetuses, the CD was successfully measured.Positively correlations between the conus distance and the gestational age was observed.The CD was (10.0± 3.3) mm at ＞ 14-≤ 15 weeks (n=17), (27.7±3.8) mm at ＞ 20-≤ 21 weeks of gestation (n=18), (41.5±2.4) mm at ＞ 26-≤ 27 weeks (n=8), (54.7±3.0) mm at ＞ 32-≤ 33 weeks (n=17), and (71.9±2.7) mm at ＞ 41-≤ 42 weeks (n=6).Linear regression correlations between CD (mm) and FL, AC, HC, BPD and GA were:CD=1.04× FL (mm)-8.71, CD=0.23 × AC (mm)-10.11, CD=0.28× HC (mm)-18.10, CD=0.90× BPD (mm)-17.65, CD=2.34× GA (weeks)-20.94 (r=0.990, 0.985, 0.978, 0.974 and 0.973, respectively, all P ＜ 0.01).The measurement of the conus distance exhibited good reproducibility between different operators (ICC=0.984, 95％CI: 0.972-0.991) and for the same operator (ICC=0.992, 95％CI: 0.985-0.995) with the 95％ limits of agreement of-1.8 to 3.5 mm and-4.3 to 2.1 mm.Bland-Altman analysis showed that most of the measured values were within 95％ confidence interval suggesting good consistency.Conclusions The distance, between the end of the conus medullaris and the end of the last vertebral body under ultrasound scan, is positively correlated with FL and other ultrasonographic indicators, which implies that it could be used as a new index for position of fetal conus medullaris.
