Glotzbecker Michael P, Estroff Judy A, Spencer Samantha A, Bosley Justin C, Parad Richard B, Kasser James R, Mahan Susan T
Children's Hospital Boston, Boston, MA 02115, USA.
J Pediatr Orthop. 2010 Sep;30(6):606-11. doi: 10.1097/BPO.0b013e3181e78e4e.
Improvements in obstetric sonography (US) have led to an increased prenatal detection of clubfoot, but studies have not been able to correlate sonographic severity to clinical deformity at birth. The purpose of this study was to decrease the false positive (FP) rate for prenatally identified clubfeet, and to predict clinical severity using a new prenatal sonographic classification system.
We retrospectively identified all pregnant patients referred to the fetal care center at our institution for a diagnosis of clubfoot between 2002 and 2007. A total of 113 fetuses were identified. Follow-up information was available for 107 fetuses (95%). Out of 107 fetuses, 17 were terminated or died shortly after birth. Seven patients had normal studies or were not seen at our center. Out of 83 patients, 42 had an US available for rereview. A novel sonographic severity scale for clubfoot (mild/moderate/severe) was assigned by a radiologist specializing in prenatal US to each fetus based on specific anatomic features. The prenatal sonographic scores were then assessed with respect to final postnatal clinical diagnosis and to clinical severity.
None of the pregnancies were terminated because of an isolated diagnosis of clubfoot. Of the remaining 83 fetuses with a prenatal diagnosis of at least 1 clubfoot, 67 had a clubfoot documented at birth (FP=19%). A foot classified as "mild" on prenatal US was significantly less likely to be a true clubfoot at birth than when a "moderate" or "severe" diagnosis was given (Odds Ratio=21, P<0.0001). If "mild" clubfoot patients were removed from the analysis, our FP rate decreased to 3/42. For a subgroup in which postnatal DiMeglio scoring was available, prenatal sonographic stratification of clubfoot did not relate to postnatal clinical severity.
Our initial experience with this novel sonographic scoring system showed improved detection of a true clubfoot prenatally and a decrease in the FP rate. An isolated "mild" clubfoot diagnosed on a prenatal sonogram is less likely to be a clubfoot at birth; this will have substantial impact on prenatal counseling.
Level III Diagnostic Study.
产科超声检查（US）的改进使得产前发现马蹄内翻足的情况增多，但研究尚未能够将超声检查的严重程度与出生时的临床畸形相关联。本研究的目的是降低产前诊断马蹄内翻足的假阳性（FP）率，并使用一种新的产前超声分类系统预测临床严重程度。
我们回顾性确定了2002年至2007年间转诊至我院胎儿护理中心诊断马蹄内翻足的所有孕妇。共确定了113例胎儿。107例胎儿（95%）有随访信息。在107例胎儿中，17例在出生后不久终止妊娠或死亡。7例患者检查结果正常或未在我院就诊。在83例患者中，42例有超声检查可供重新评估。一位专门从事产前超声的放射科医生根据特定解剖特征为每个胎儿指定了一种新的马蹄内翻足超声严重程度评分（轻度/中度/重度）。然后根据最终的产后临床诊断和临床严重程度评估产前超声评分。
没有因为单纯诊断马蹄内翻足而终止妊娠。在其余83例产前诊断至少有1例马蹄内翻足的胎儿中，67例出生时记录有马蹄内翻足（FP = 19%）。产前超声分类为“轻度”的足部在出生时为真正马蹄内翻足的可能性明显低于诊断为“中度”或“重度”时（优势比 = 21，P < 0.0001）。如果将“轻度”马蹄内翻足患者排除在分析之外，我们的FP率降至3/42。对于有产后DiMeglio评分的亚组，马蹄内翻足的产前超声分层与产后临床严重程度无关。
我们使用这种新的超声评分系统的初步经验表明，产前对真正马蹄内翻足的检测有所改善，且FP率降低。产前超声检查诊断为单纯“轻度”马蹄内翻足在出生时为马蹄内翻足的可能性较小；这将对产前咨询产生重大影响。
III级诊断研究。
