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目的:运用二维彩色多普勒及实时三维成像探讨胎儿小下颌畸形的超声表现及各指标综合诊断方法,提高其超声诊断准确率,总结其临床应用价值。方法:应用二维彩色多普勒超声测量6 300例孕周为18-32周的胎儿下颌骨纵径(FML),左右径,下颌骨纵径与双顶径的比值即下颌指数(JI),胎儿下颌面部角度(IFA)。观察胎儿正中矢状面下颌曲线及冠状面下颌显像,并应用实时三维表面成像技术进一步显示胎儿下颌结构。结果:正常胎儿下颌骨左右径及纵径FML与其孕周正相关(R分别为0.952,0.954,P均<0.01);小下颌组胎儿JI、IFA较正常对照组胎儿显著减小,差异有统计学意义(P<0.05),FML明显小于正常同孕周胎儿。结论:胎儿FML明显小于同孕周正常值,JI<31%,IFA<45%为产前诊断小下颌畸形的超声综合数据指标,二维及实时三维彩超联合应用诊断胎儿小下颌畸形明显优于传统诊断方法,具有其他影像学检查不可取代的临床应用价值。
OBJECTIVE: To investigate the ultrasound manifestations of fetal small mandibular deformity and comprehensive diagnosis of various indexes by using two-dimensional color Doppler and real-time three-dimensional imaging to improve the accuracy of ultrasonic diagnosis and summarize its clinical value. Methods: Fetal mandibular longitudinal diameter (FML) of 6 300 pregnant women with gestational age of 18-32 weeks was measured by two-dimensional color Doppler ultrasonography. The ratios of mandibular longitudinal diameter to biparietal diameter, that is, mandibular index (JI) , Fetal mandibular face angle (IFA). The mandibular curve of the median sagittal plane and the coronal plane were observed. Real-time three-dimensional surface imaging was used to further reveal the mandibular structure of the fetus. Results: The left and right mandibular diameter and longitudinal FML of normal fetus were positively correlated with gestational age (R = 0.952,0.954, P <0.01 respectively). The fetal JI and IFA in small mandibular group were significantly lower than those in normal control group, with statistical differences Significance (P <0.05), FML was significantly less than the normal gestational age fetus. Conclusion: FML of fetus is obviously less than the normal value of gestational week, with JI <31% and IFA <45%, which is the comprehensive ultrasonic data index for prenatal diagnosis of small chin deformity. The application of 2D and real-time 3D color Doppler ultrasound in diagnosing small chin malformation is superior to Traditional diagnostic methods, with other imaging studies irreplaceable clinical value.