产前超声诊断先天性马蹄内翻足的应用价值

目的　探讨产前超声诊断先天性马蹄内翻足的应用价值。 方法　选取2016-2019年于我院就诊的38例（44只患足）先天性马蹄内翻足患儿作为观察组，筛查时间为孕周20～26周，另选取同期于我院检查正常的胎儿35例（70只足）作为对照组。应用彩色超声诊断仪分别测量2组足长(FL)及足宽(FW)，并计算FL/FW值；采用Dimeglio法评估患儿病情严重程度，并分析其与FL、FW及FL/FW的相关性，采用ROC法分析FL、FW及FL/FW诊断先天性马蹄内翻足的临床价值。 结果　与对照组比较，观察组患儿FL及FL/FW值较小，而FW值较大，且均有统计学差异（P<0.05）；不同Dimeglio分级的FL、FW及FL/FW比较差异显著（P<0.05），FL及FL/FW值随Dimeglio分级升高而逐渐减小（P<0.05），而FW值随Dimeglio分级升高而逐渐增大（P<0.05）；Spearman分析显示，FW与 Dimeglio评分呈正相关，而FL和FL/FW与 Dimeglio评分呈负相关（P<0.05）；ROC分析显示，FL、FW及FL/FW诊断先天性马蹄内翻足的曲线下面积分别为0.723（95%CI：0.591～0.926，P =0.005）、0.661（95%CI：0.522~0.849，P =0.017）、0.835（95%CI：0.709~0.984，P<0.001），最佳诊断截断值依次为4.01、2.49、1.92，诊断灵敏度和特异度分别为80.73和81.26、81.07和78.93、90.13和90.74，经分析，FL/FW对先天性马蹄内翻足的诊断价值最大。 结论　产前超声对临床准确诊断先天性马蹄内翻足具有重要参考价值。

Application value of prenatal ultrasound in the diagnosis of congenital valgus foot

Objective　To explore the application value of prenatal ultrasound in the diagnosis of congenital valgus foot. 　Methods　To select thirty-eight children (44 affected feet) with congenital horseshoe varus treated in our hospital from January 2016 to January 2019 as the observation group, and the screening time is 20 to 26 weeks of pregnancy. Another 35 cases of fetuses (70 feet) who were normal in our hospital during the same period were selected) as a control group. Color ultrasound diagnostic equipment was used to measure the foot length (FL) and foot width (FW) of the two groups, and the FL / FW value was calculated the children's disease severity was evaluated using the Dimeglio method, and their relationship with FL, The correlation between FW and FL / FW. The clinical value of FL, FW and FL / FW in the diagnosis of congenital varus equivatus were analyzed by ROC method. Results Compared with the control group, the children in the observation group had smaller FL and FL / FW values, while the FW values were larger, and the differences were statistically significant (P<0.05); there were differences in FL, FW, and FL/FW between different Dimeglio grades. All were statistically significant (P<0.055). FL and FL/FW values gradually decreased with the increase of Dimeglio classification (P<0.05), while FW values gradually increased with the increase of Dimeglio classification (P<0.05); Spearman analysis showed that FW was positively correlated with Dimeglio score, while FL and FL/FW were negatively correlated with Dimeglio score (P<0.05); ROC curve analysis showed that FL, FW and FL/FW diagnosed congenital valgus. The areas under the curve are 0.723 (95% CI: 0.591 to 0.926, P = 0.005), 0.661 (95% CI: 0.522 to 0.849, P=0.017), and 0.835 (95% CI: 0.709 to 0.984, P<0.001). The best diagnostic cutoff values are 4.01, 2.49 and 1.92, respectively, and the diagnostic sensitivity and specificity are 80.73 and 81.26, 81.07 and 78.93, 90.13, and 90.74. FL / FW has the largest diagnostic value for congenital valgus. Conclusions Prenatal ultrasound has important reference value for clinically accurate diagnosis of congenital horseshoe varus.