胎儿生物学参数超声参考值专家共识——肱骨长、桡骨长、尺骨长、胫骨长、腓骨长、足长

共识 妇产科· 产科与妊娠 · 中华医学会超声医学分会

·专家共识·

# 胎儿生物学参数超声参考值专家共识——肱骨长、桡骨长、尺骨长、胫骨长、腓骨长、足长

中华预防医学会出生缺陷预防与控制专业委员会产前超声诊断学组 妇产学组

中华医学会超声医学分会

股骨长、肱骨长、桡骨长、尺骨长、胫骨长、腓骨长等胎儿四肢长骨长度以及胎儿足长在胎儿发育评估和骨骼系统异常鉴别诊断中发挥着重要作用。选择合适的胎儿四肢长骨长度和足长正常参考值对胎儿临床管理决策尤为重要。

目前,国内外已有多个胎儿四肢长骨长度和足长超声正常参考值的相关研究(股骨长超声参考值已形成共识[1]),但这些研究在研究设计、样本量、数据来源、纳排标准以及统计方法等方面存在着较大差异。此外,不同医院、医师使用不同的参考值,可能对胎儿生长状况的判断存在差异,影响后续的临床决策。本研究根据国内外重要指南和相关文献,在循证医学的基础上结合专家建议,形成胎儿四肢长骨长度和足长的超声正常参考值推荐专家共识。

一、定义

除股骨长外,临床常用的胎儿四肢长骨长度超声测量指标包括:肱骨长、桡骨长、尺骨长、胫骨长和腓骨长[2]。胎儿长骨长度是指骨化的长骨干的长度,即上下干骺端之间的距离[2-5]。足长是指胎儿足跟至最长趾尖的距离[5],胎足的第一或第二趾通常为最长。

二、测量时机

关于胎儿四肢骨长度测量时机目前尚无统一的共识。根据《超声产前筛查指南》(2022版)[3],

肱骨长为20~24$^{+6}$周测量指标,而其他长骨属于观察性指标,当疑似胎儿骨骼发育异常时,建议测量其长度,并与正常参考值进行比对[2]。

三、测量方法

根据《超声产前筛查指南》(2022版)[3]及其临床实践,推荐以下测量方法(表1和图1)。

表1 胎儿肱骨长、桡骨长、尺骨长、胫骨长、腓骨长和足长的测量方法

|参数|测量切面|切面要求及观察内容|游标放置位置| |---|---|---|---| |肱骨长|肱骨长轴切面|切面要求:显示肱骨长轴(双侧) 观察内容:观察肱骨形态、长短|测量骨化的肱骨干骺端中点之间的距离| |尺骨长、桡骨长|尺、桡骨长轴切面|切面要求:同时显示尺骨和桡骨长轴(双侧) 观察内容:观察尺、桡骨的形态、长短|测量骨化的尺骨或桡骨干骺端中点之间的距离| |胫骨长、胫、腓骨长轴切面|胫、腓骨长轴切面|切面要求:同时显示胫骨和腓骨长轴(双侧) 观察内容:观察腔、腓骨的形态、长短|测量骨化的胫骨或腓骨干骺端中点之间的距离| |足长|足底切面|显示足底前端足趾(前足部)、足弓(中足部)和足跟(后足部)|测量游标置于足跟部皮肤外缘到最长脚趾的末端皮肤外缘|

四、质控要点

本共识基于《超声产前筛查指南》(2022版)[3]及其临床实践,并借鉴 Salomon 等[6]的质控方法,制定了肱骨、尺骨、桡骨、胫骨、腓骨长轴切面以及足底切面及其测量的质控要点(表2)。

$\cdot$ 290 $\cdot$

中华医学超声杂志(电子版)2025年4月第22卷第4期 Chin J Med Ultrasound(Electronic Edition), April 2025, Vol.22, No.4

![HANDHANDRLRLHL-ULUL1aFiLFiFoLFoLTLFOOTFOOTPL\n](1/parseimages/figurebc6ea3eb14ac44daa4b1e5feffd4cea4_0_2.png) 注:HL为肱骨长;RL为桡骨长;UL为尺骨长;TL为胫骨长;FiL为腓骨长;FoL为足长;HAND为手;FOOT为足图1 胎儿肱骨长、桡骨长、尺骨长、胫骨长、腓骨长和足长的测量切面、测量方法及模式图。图a为肱骨长的超声图像及模式图;图b为桡骨长、尺骨长的超声图像及模式图;图c为胫骨长、腓骨长的超声图像及模式图;图d为足长的超声图像及模式图

表2 胎儿不同长骨和足长超声测量切面及质控要点

|测量切面|测量指标|质控要点| |---|---|---| |肱骨长轴切面|肱骨长|①长骨上下两侧的干骺端清晰显示 ②声束尽可能垂直于长骨长轴(长轴与水平线的夹角<15°) ③感兴趣区图像放大至超声图像区域50%以上| |尺、桡骨长轴切面|尺骨长、 桡骨长|④测量游标放置正确| |胫、腓骨长轴切面|胫骨长、 腓骨长|同肱骨质控要点| |足底切面|足长|①足底前端足趾(前足部)清晰显示 ②足跟(后足部)清晰显示 ③声束尽可能垂直于足底长轴|

五、正常参考值推荐

本共识系统检索了国内外胎儿四肢长骨长度和足长正常参考值的研究,重点聚焦同时涵盖长骨长度和足长的文献,共纳入12篇[5, 7-18]。

在此基础上,本研究采用牛津大学推荐的正常参考值研究质量评价方法[19]对以上参考值研究进行分析,并遵循推荐原则[20],结合专家建议,遴选出当前共识度较高的超声参考值。最终本共识推荐2002年英国学者Chitty等[5]发表的单胎胎儿四肢长骨长度和足长超声参考值(百分位数表和Z分数表分别见表3和表4)。

根据推荐原则[20],该研究质量评分最高,发

表年代较新,采用的测量方法与我国指南的要求一致[3]。然而,该参考值研究仍存在不足,如单中心研究、样本量偏小(663例)、未包含中国孕妇人群、未经过头臂长矫正孕龄等。

六、临床意义

当发现疑似胎儿骨骼发育不良时,对胎儿股骨长、肱骨长、桡骨长、尺骨长、胫骨长、腓骨长等胎儿四肢长骨以及足长[21]的精确测量对于疾病发生风险的识别和诊断具有重要意义。目前判断这些长骨长度异常的截断值尚未统一,常用的是长骨长度小于第5百分位数或小于均数-2SD[21-22]。胎儿骨骼发育不良发生风险和严重程度随长骨缩短而增加,当长骨长度小于均数-4SD时,胎儿发生致死性骨骼发育不良的风险明显增加[23]。

当超声检查发现长骨短时,首先应核对孕龄[24]并进行重复测量,避免因孕龄不准确或测量误差导致误判。同时,应参考其他超声参数指标,如长骨形态、骨化情况、心胸比值、是否存在其他结构畸形、多普勒血流以及股骨长与头围、腹围、胸围、足长的比值等,并结合家族史和临床相关情况进行疾病发生风险的判断。定期进行超声检查、动态评估和随访,必要时,可行分子遗传学基因检测进一步明确诊断。

本共识推荐的胎儿生物学参数超声参考值仅作为辅助性工具使用,不应被视为判断的唯一标

|孕龄(周)|肱骨长(mm)|肱骨长(mm)|肱骨长(mm)|肱骨长(mm)|桡骨长(mm)|桡骨长(mm)|桡骨长(mm)|桡骨长(mm)|尺骨长(mm)|尺骨长(mm)|尺骨长(mm)|尺骨长(mm)|胫骨长(mm)|胫骨长(mm)|胫骨长(mm)|胫骨长(mm)|腓骨长(mm)|腓骨长(mm)|腓骨长(mm)|腓骨长(mm)|足长(mm)|足长(mm)|足长(mm)|足长(mm)|足长(mm)||||||| |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| |孕龄(周)|3rd|5th|50th|95th|97th|3rd|5th|50th|95th|97th|3rd|5th|50th|95th|97th|3rd|5th|50th|95th|97th|3rd|5th|50th|95th|97th||||||| |12|3.7|4.1|7.1|10.1|10.6|2.2|2.6|5.5|8.4|8.8|3.9|4.4|7.3|7.3|10.3|7.3|4.5|7.6|10.4|8.8|9.6|10.0|5.9|6.3|8.9|11.5|11.8||||| |13|7.2|7.6|10.7|13.8|14.2|4.8|5.3|8.2|11.2|11.6|6.2|6.6|9.6|12.7|13.1|5.9|6.3|9.2|12.0|12.4|5.2|5.6|8.5|11.4|11.8|8.5|8.9||||| |14|10.5|11.0|14.1|17.2|17.7|7.6|8.0|11.0|14.1|14.5|8.8|9.3|12.4|15.5|19.8|8.0|8.5|11.4|14.8|7.4|7.9|10.8|13.8|14.2|11.3|11.7|14.6||||| |15|13.7|14.1|17.3|20.6|21.0|10.3|10.8|13.9|17.0|17.4|11.6|12.1|15.3|18.5|19.8|10.6|11.0|14.1|17.1|17.6|10.0|13.5|16.6|17.0|14.0|14.5|17.6||||| |16|16.7|17.2|20.4|23.7|24.2|13.0|13.5|16.7|19.8|20.3|14.5|15.0|18.2|21.5|22.0|13.3|13.8|16.9|20.1|20.5|13.6|16.4|19.5|20.0|16.8|17.3|20.6||||| |17|19.6|20.1|23.4|26.7|27.2|15.6|16.1|19.3|22.6|23.1|17.3|17.8|21.2|24.5|25.0|16.6|16.6|19.9|23.1|23.6|15.0|23.6|20.1|22.0|23.6|27.6|27.6||||| |18|22.3|22.8|26.2|29.6|30.1|18.1|18.6|21.9|25.2|25.7|20.1|20.6|24.0|27.5|27.9|19.0|19.5|22.8|26.1|22.2|25.5|26.0|22.4|22.9|26.6|30.3|30.8||||| |19|24.9|25.4|28.9|32.4|32.9|20.4|20.9|24.3|27.8|28.2|22.8|23.3|26.8|30.3|30.8|21.8|22.3|25.7|29.1|21.2|21.7|25.1|28.5|29.0|25.2|25.8|29.6||||| |20|27.4|28.0|31.5|35.0|35.5|22.7|23.2|26.7|30.2|30.6|25.3|25.8|25.8|29.4|33.0|33.5|24.5|25.0|28.5|32.0|33.5|24.4|27.1|31.3|28.0|28.6|32.6||||| |21|29.8|30.4|34.0|37.6|38.1|24.8|25.3|28.9|32.4|32.9|27.7|28.3|32.0|35.6|36.2|27.1|27.7|31.2|34.8|35.3|34.1|34.6|30.8|31.4|35.6|39.8|40.4||||| |22|32.1|32.7|36.3|40.0|40.5|26.8|27.3|30.9|34.6|35.1|30.1|30.6|34.4|38.1|38.7|29.7|30.2|33.9|37.5|38.0|28.9|29.4|33.1|36.8|37.3|33.5|34.2||||| |23|34.3|34.8|38.6|42.3|42.9|28.6|29.2|32.9|36.6|37.1|32.3|32.8|36.6|40.5|41.0|32.1|32.6|36.4|40.1|40.7|31.2|31.8|35.3|39.3|36.2|36.9|41.5|46.0|46.7||| |24|36.4|36.9|40.7|44.6|45.1|30.4|30.9|34.7|38.5|39.1|34.3|34.9|38.8|42.7|43.3|34.4|34.9|38.8|42.6|43.2|33.5|34.0|37.9|41.7|42.3|38.9|39.6|44.4|49.1||| |25|38.4|38.9|42.8|46.7|47.2|32.0|32.6|36.5|40.3|40.9|36.3|36.9|40.9|44.9|45.5|36.5|37.1|41.0|45.0|45.5|35.6|36.2|40.1|44.0|44.6|41.5|42.3|47.2|52.1|52.8|| |26|40.3|40.9|44.8|48.7|49.3|33.6|34.2|38.1|42.1|42.6|38.2|38.8|42.8|42.8|46.9|47.5|38.6|39.2|43.2|47.3|47.8|37.6|38.2|42.2|46.3|46.8|44.1|44.8|50.0|55.1|55.8| |27|42.1|46.7|50.7|51.3|35.1|35.7|39.7|43.7|44.3|39.9|40.5|44.7|48.9|49.5|40.6|41.2|45.3|49.4|50.0|44.3|48.4|44.3|48.4|49.0|46.6|47.4|52.7|58.0|58.7||| |28|43.9|44.4|48.5|52.6|36.3|41.1|42.3|45.8|41.8|42.2|46.5|50.7|51.3|42.5|43.1|47.5|51.3|52.1|41.4|42.0|46.2|50.4|51.9|49.1|49.8|55.3|60.8|61.6|61.6|62.0|61.6| |29|45.5|46.1|50.2|54.4|55.0|37.8|38.4|42.6|46.7|47.3|43.2|43.8|48.2|52.5|48.4|44.3|44.8|45.4|43.8|54.0|52.9|54.1|52.2|57.9|63.5|64.3|64.3||||| |30|47.1|47.7|51.9|56.7|39.0|39.6|43.9|48.1|48.7|44.7|45.3|49.8|54.2|54.8|46.0|46.6|51.0|55.4|56.0|44.8|55.4|54.0|54.8|54.8|54.5|66.2|62.0|67.0|62.0||| |31|48.6|49.2|53.5|57.7|58.4|40.2|40.8|45.1|49.5|50.1|46.1|46.8|51.3|55.8|46.2|51.3|55.8|56.4|47.6|48.3|52.7|57.8|56.8|47.0|51.5|55.9|56.8|62.8|68.8||| |32|50.0|50.6|55.0|59.3|59.9|41.3|41.9|46.8|51.4|47.5|48.2|52.7|48.2|52.7|57.3|57.9|57.4|48.9|58.4|59.9|59.6|47.9|58.5|58.0|58.0|69.5|61.5|71.2|72.1||| |34|52.7|53.3|57.8|62.3|62.9|43.4|44.0|48.6|53.1|53.8|50.0|50.7|55.4|60.2|50.8|60.8|58.9|54.1|58.8|50.9|59.4|59.2|59.9|60.0|60.8|69.4|75.9|76.8|||| |35|53.9|54.6|59.1|63.6|64.3|44.3|45.0|49.6|54.3|54.9|51.2|51.9|56.7|61.5|62.2|53.4|54.1|58.9|63.7|64.4|52.0|52.6|57.5|62.3|63.0|63.7|71|||||

注:3rd、5th、50th、95th、97th分别表示第3、5、50、95、97百分位数

|孕龄(周)|肱骨长(mm)|肱骨长(mm)|肱骨长(mm)|肱骨长(mm)|桡骨长(mm)|桡骨长(mm)|桡骨长(mm)|桡骨长(mm)|尺长(mm)|尺长(mm)|尺长(mm)|尺长(mm)|胫骨长(mm)|胫骨长(mm)|胫骨长(mm)|胫骨长(mm)|腓骨长(mm)|腓骨长(mm)|腓骨长(mm)|腓骨长(mm)|足长(mm)|足长(mm)|足长(mm)|足长(mm)|足长(mm)||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---| |孕龄(周)|-3SD|-2SD|均数|+2SD|+3SD|-3SD|-2SD|均数|+2SD|+3SD|-3SD|-2SD|均数|+2SD|+3SD|-3SD|-3SD|-2SD|均数|+2SD|-3SD|均数|+2SD|-3SD|均数||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |12|1.6|3.5|7.1|10.8|12.6|0.3|2.0|5.5|9.0|10.8|1.9|3.7|7.3|10.9|12.7|2.5|4.2|7.6|11.1|12.8|1.7|3.4|6.8|10.2|11.9|4.1|5.7||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |13|5.1|7.0|10.7|14.4|16.3|2.8|4.6|8.2|11.8|13.6|4.1|6.0|9.6|13.3|15.2|3.9|5.6|9.2|12.7|14.4|3.2|5.0|8.5|12.0|13.7|6.7|8.3||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |14|8.4|10.3|14.1|17.9|19.8|5.5|7.3|11.0|14.7|16.6|6.7|8.6|12.4|16.0|18.0|6.0|7.8|11.4|15.0|16.8|5.4|7.2|10.8|14.4|16.2|9.2|11.0||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |15|11.5|13.4|17.3|21.2|23.2|8.2|10.1|13.9|17.7|19.5|9.5|11.4|15.3|19.2|21.1|8.5|10.3|14.1|17.8|9.6|8.0|9.8|13.5|17.2|19.1|11.9|13.8||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |16|14.5|16.5|20.4|24.4|26.4|10.8|12.8|16.7|20.5|22.5|12.3|14.3|18.2|22.2|24.2|11.2|13.1|16.9|20.7|22.7|10.7|12.6|16.4|20.2|22.1|14.5|16.5||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |17|17.3|19.3|23.4|27.5|29.5|13.4|15.4|19.3|23.3|25.3|15.0|17.1|21.2|25.2|27.3|14.0|15.9|19.9|23.8|25.7|13.4|15.4|19.3|23.2|25.2|17.2|19.3||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |18|20.0|22.1|26.2|30.4|32.4|15.8|17.8|21.9|26.0|28.0|17.8|19.8|24.0|28.2|30.3|16.8|18.8|22.8|26.8|28.8|16.2|18.2|26.3|28.3|19.9|22.1|26.6|31.1|33.3||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |19|22.6|24.7|28.9|33.1|15.3|18.1|20.2|24.3|28.5|30.6|20.4|22.5|26.8|31.1|33.2|19.5|21.6|25.7|29.8|31.9|18.9|20.9|25.1|29.2|31.3|22.6|24.9|29.6|34.3|36.6|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |20|25.0|27.2|31.5|35.8|38.0|20.3|22.4|26.7|30.9|33.0|22.9|35.4|22.9|25.1|29.4|33.8|36.0|22.2|24.3|28.5|32.7|34.8|21.5|23.6|27.9|32.1|24.2|25.3|27.7|32.6|37.5|40.0|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||| |21|27.4|29.6|34.0|38.3|40.5|22.3|24.5|28.9|33.2|35.4|25.2|27.5|32.4|25.7|32.0|36.4|38.7|24.8|26.9|31.2|35.6|30.9|34.9|37.0|27.9|30.5|35.6|40.7|43.3|36.6|40.7|43.3|35.6|40.7|37.0|29.9|30.5|35.6|40.7|43.3|36.6|39.0|40.9|43.1|28.6|39.4|31.3|43.6|29.6|31.8|36.4|40.9|43.1|43.6|29.6|31.8|36.4|40.9|43.1|28.7|31.0|35.5|35.7|40.1|42.4|33.1|35.9|41.5|47.0|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|49.8|30.9|34.0|39.2|37.9|42.5|44.9|35.7|38.6|44.4|50.1|53.0|54.0|58.8|58.8|64.7|58.8|65.2|38.2|38.2|38.4|37.0|38.4|38.0|38.4|38.4|38.0|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.7|38.4|38.4|38.7|38.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|38.7|39.4|39.4|38.7|39.4|38.7|39.4|38.7|39.4|<start>12<|

注:该表的数据由文献[5]中的公式推算而来;该算法已集成于“优生智算”微信小程序在线计算平台,以便于使用;SD为标准差

中华医学超声杂志(电子版)2025年4月第22卷第4期 Chin J Med Ultrasound(Electronic Edition), April 2025, Vol.22, No.4

$\cdot$ 293 $\cdot$

准,临床应用中需综合考虑种族及个体差异、技术限制、遗传因素等临床实际情况进行综合评估。同时,当依据本共识推荐的参考值得到的结果与临床实践偏差较大时,如有需要,可结合其他的参考值进行综合判断。

专家共识编写组成员

组长:李胜利(深圳市妇幼保健院);吴青青(首都医科大学附属北京妇产医院);朱军(四川大学华西第二医院)

执笔人: 赵建新(四川大学华西第二医院); 王玉吉(四川大学华西第二医院); 唐瑶(贵州医科大学附属医院)

参与讨论的专家(按姓氏拼音排序):陈素华(华中科技大学同济医院);陈欣林(湖北省妇幼保健院);戴晴(中国医学科学院北京协和医院);邓学东(南京医科大学附属苏州医院);高新茹(西北妇女儿童医院);纪学芹(北京大学第一医院宁夏妇女儿童医院);栗河舟(河南省妇幼保健院);李胜利(深圳市妇幼保健院);李天刚(甘肃省妇幼保健院);刘国辉(内蒙古自治区妇幼保健院);刘艳秋(江西省妇幼保健院);罗红(四川大学华西第二医院);骆迎春(湖南省妇幼保健院);马燕琳(海南医科大学第一附属医院);裴秋艳(北京大学人民医院);冉素真(重庆市妇幼保健院);任芸芸(复旦大学附属妇产科医院);尚宁(广东省妇幼保健院);史莉玲(山西省妇幼保健院);宋文龄(吉林大学第一医院);孙路明(上海交通大学医学院附属新华医院);唐瑶(贵州医科大学附属医院);田瑞霞(中国人民解放军联勤保障部队第九〇一医院);王艳萍(四川大学华西第二医院);瓦迎芳(青海省妇幼保健院);文华轩(深圳市妇幼保健院);吴青青(首都医科大学附属北京妇产医院);谢红宁(中山大学附属第一医院);严英榴(复旦大学附属妇产科医院);杨家翔(四川省妇幼保健院);尹爱华(广东省妇幼保健院);尹虹(山东省妇幼保健院);赵胜(湖北省妇幼保健院);周祎(中山大学附属第一医院);周欣(江西省妇幼保健院);周毓青(上海市长宁区妇幼保健院);朱军(四川大学华西第二医院)

志谢 四川大学华西第二医院陈春屹、周嘉园、康红、崔浪、吴元元、武卓越、黄程、曾琴在共识研讨和制定过程中提供了帮助

参考文献

1 中华预防医学会出生缺陷预防与控制专业委员会产前超声诊断学组,中华医学会超声医学分会妇产学组,胎儿生物学参数超声参考值专家共识:双顶径、头围、腹围和股骨长[J/OL].中华医学超声杂志(电子版),2024,21(8):757-761.

2 Salomon LJ, Alfirevic Z, Berghella V, et al. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan [J]. Ultrasound Obstet Gynecol, 2022, 59(6): 840-856. 3 中华医学会超声医学分会妇产超声学组,国家卫生健康委妇幼司全国产前诊断专家组医学影像组.超声产前筛查指南[J].中华超声影像学杂志,2022,31(1): 1-11. 4 Sidhu PS, Chong WK, Satchithananda K. Measurement in ultrasound [M]. 2nd ed. Boca Raton: CRC Press, 2016: 316-328. 5 Chitty LS, Altman DG. Charts of fetal size: limb bones [J]. BJOG, 2002, 109(8): 919-929. 6 Salomon LJ, Winer N, Bernard JP, et al. A score-based method for quality control of fetal images at routine second-trimester ultrasound examination [J]. Prenat Diagn, 2008, 28(9): 822-827. 6 孙昭,吴秀芬,杨太珠.超声检测胎儿四肢长骨及其与胎龄的相关分析[J].华西医科大学学报,1996,27(2): 206-208. 8 李丽雅,吕国荣,苏瑞娟.超声测量胎儿四肢长骨及足长与孕龄的相关性研究[J].中国医学影像技术,2006,22(11): 1739-1741. 9 De Biasio P, Prefumo F, Lantieri PB, et al. Reference values for fetal limb biometry at 10-14 weeks of gestation [J]. Ultrasound Obstet Gynecol, 2002, 19(6): 588-591. 10 Zorzoli A, Kustermann A, Caravelli E, et al. Measurements of fetal limb bones in early pregnancy [J]. Ultrasound Obstet Gynecol, 1994, 4(1): 29-33. 11 Jeanty P, Cousaert E, Cantraine F, et al. A longitudinal study of fetal limb growth [J]. Am J Perinatol, 1984, 1(2): 136-144. 12 Queenan JT, O'Brien GD, Campbell S. Ultrasound measurement of fetal limb bones [J]. Am J Obstet Gynecol, 1980, 138(3): 297-302. 13 Jeanty P, Kirkpatrick C, Dramaix-Wilmet M, et al. Ultrasonic evaluation of fetal limb growth [J]. Radiology, 1981, 140(1): 165-168. 14 Issel EP Ultrasonic measurement of the growth of fetal limb bones in normal pregnancy [J]. J Perinat Med, 1985, 13(6): 305-313. 15 Merz E, Kim-Kern MS, Pohl S. Ultrasonic mensuration of fetal limb bones in the second and third trimesters [J]. J Clin Ultrasound, 1987, 15(3): 175-183. 16 Exacoustos C, Rosati P, Rizzo G, et al. Ultrasound measurements of fetal limb bones [J]. Ultrasound Obstet Gynecol, 1991, 1(5): 325-330. 17 Westerway SC, Davison A, Cowell S. Ultrasonic fetal measurements: new Australian standards for the new millennium [J]. Aust N Z J Obstet Gynaecol, 2000, 40(3): 297-302. 18 Kasraeian M, Shahraki HR, Asadi N, et al. Cross-sectional study of fetal long-bone length in an Iranian population at 17-25 weeks of gestation [J]. Int J Gynaecol Obstet, 2017, 137(1): 20-25. 19 Ioannou C, Talbot K, Ohuma E, et al. Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size [J]. BJOG, 2012, 19(12): 1425-1439. 20 中华预防医学会出生缺陷预防与控制专业委员会产前超声诊断学组,中华医学会超声医学分会妇产学组.胎儿生物学参数超声参考值专家共识:总论[JOL].中华医学超声杂志(电子版),2024, 21(8): 753-756. 21 Krakow D, Lachman RS, Rimoin DL. Guidelines for the prenatal diagnosis of fetal skeletal dysplasias [J]. Genet Med, 2009, 11(2): 127-133. 22 Savarirayan R, Rossiter JP, Hoover-Fong JE, et al. Best practice

$\cdot$ 294 $\cdot$

中华医学超声杂志(电子版)2025年4月第22卷第4期 Chin J Med Ultrasound(Electronic Edition), April 2025, Vol.22, No.4

guidelines regarding prenatal evaluation and delivery of patients with skeletal dysplasia [J]. Am J Obstet Gynecol, 2018, 219(6): 545-562.

23 李胜利,罗国阳.胎儿畸形产前超声诊断学[M].第2版.北京:科学出版社,2017:727-729.

24 中华预防医学会出生缺陷预防与控制专业委员会产前超声诊断学组,中华医学会超声医学分会妇产学组,胎儿生物学参数超声参

考值专家共识: 孕龄 [J/OL]. 中华医学超声杂志(电子版), 2025, 22(4): 283-288.

(收稿日期: 2025-03-12)

(本文编辑: 汪荣)

中华预防医学会出生缺陷预防与控制专业委员会产前超声诊断学组,中华医学会超声医学分会妇产学组,胎儿生物学参数超声参考值专家共识——肱骨长、桡骨长、尺骨长、胫骨长、腓骨长、足长[J/OL].中华医学超声杂志(电子版),2025,22(4): 289-294.

表1 胎儿肱骨长、桡骨长、尺骨长、胫骨长、腓骨长和足长的测量方法
参数测量切面切面要求及观察内容游标放置位置
肱骨长肱骨长轴切面切面要求:显示肱骨长轴(双侧) 观察内容:观察肱骨形态、长短测量骨化的肱骨干骺端中点之间的距离
尺骨长、桡骨长尺、桡骨长轴切面切面要求:同时显示尺骨和桡骨长轴(双侧) 观察内容:观察尺、桡骨的形态、长短测量骨化的尺骨或桡骨干骺端中点之间的距离
胫骨长、胫、腓骨长轴切面胫、腓骨长轴切面切面要求:同时显示胫骨和腓骨长轴(双侧) 观察内容:观察腔、腓骨的形态、长短测量骨化的胫骨或腓骨干骺端中点之间的距离
足长足底切面显示足底前端足趾(前足部)、足弓(中足部)和足跟(后足部)测量游标置于足跟部皮肤外缘到最长脚趾的末端皮肤外缘
表2 胎儿不同长骨和足长超声测量切面及质控要点
测量切面测量指标质控要点
肱骨长轴切面肱骨长①长骨上下两侧的干骺端清晰显示 ②声束尽可能垂直于长骨长轴(长轴与水平线的夹角<15°) ③感兴趣区图像放大至超声图像区域50%以上
尺、桡骨长轴切面尺骨长、 桡骨长④测量游标放置正确
胫、腓骨长轴切面胫骨长、 腓骨长同肱骨质控要点
足底切面足长①足底前端足趾(前足部)清晰显示 ②足跟(后足部)清晰显示 ③声束尽可能垂直于足底长轴
表 3
孕龄(周)肱骨长(mm)肱骨长(mm)肱骨长(mm)肱骨长(mm)桡骨长(mm)桡骨长(mm)桡骨长(mm)桡骨长(mm)尺骨长(mm)尺骨长(mm)尺骨长(mm)尺骨长(mm)胫骨长(mm)胫骨长(mm)胫骨长(mm)胫骨长(mm)腓骨长(mm)腓骨长(mm)腓骨长(mm)腓骨长(mm)足长(mm)足长(mm)足长(mm)足长(mm)足长(mm)
孕龄(周)3rd5th50th95th97th3rd5th50th95th97th3rd5th50th95th97th3rd5th50th95th97th3rd5th50th95th97th
123.74.17.110.110.62.22.65.58.48.83.94.47.37.310.37.34.57.610.48.89.610.05.96.38.911.511.8
137.27.610.713.814.24.85.38.211.211.66.26.69.612.713.15.96.39.212.012.45.25.68.511.411.88.58.9
1410.511.014.117.217.77.68.011.014.114.58.89.312.415.519.88.08.511.414.87.47.910.813.814.211.311.714.6
1513.714.117.320.621.010.310.813.917.017.411.612.115.318.519.810.611.014.117.117.610.013.516.617.014.014.517.6
1616.717.220.423.724.213.013.516.719.820.314.515.018.221.522.013.313.816.920.120.513.616.419.520.016.817.320.6
1719.620.123.426.727.215.616.119.322.623.117.317.821.224.525.016.616.619.923.123.615.023.620.122.023.627.627.6
1822.322.826.229.630.118.118.621.925.225.720.120.624.027.527.919.019.522.826.122.225.526.022.422.926.630.330.8
1924.925.428.932.432.920.420.924.327.828.222.823.326.830.330.821.822.325.729.121.221.725.128.529.025.225.829.6
2027.428.031.535.035.522.723.226.730.230.625.325.825.829.433.033.524.525.028.532.033.524.427.131.328.028.632.6
2129.830.434.037.638.124.825.328.932.432.927.728.332.035.636.227.127.731.234.835.334.134.630.831.435.639.840.4
2232.132.736.340.040.526.827.330.934.635.130.130.634.438.138.729.730.233.937.538.028.929.433.136.837.333.534.2
2334.334.838.642.342.928.629.232.936.637.132.332.836.640.541.032.132.636.440.140.731.231.835.339.336.236.941.546.046.7
2436.436.940.744.645.130.430.934.738.539.134.334.938.842.743.334.434.938.842.643.233.534.037.941.742.338.939.644.449.1
2538.438.942.846.747.232.032.636.540.340.936.336.940.944.945.536.537.141.045.045.535.636.240.144.044.641.542.347.252.152.8
2640.340.944.848.749.333.634.238.142.142.638.238.842.842.846.947.538.639.243.247.347.837.638.242.246.346.844.144.850.055.155.8
2742.146.750.751.335.135.739.743.744.339.940.544.748.949.540.641.245.349.450.044.348.444.348.449.046.647.452.758.058.7
2843.944.448.552.636.341.142.345.841.842.246.550.751.342.543.147.551.352.141.442.046.250.451.949.149.855.360.861.661.662.061.6
2945.546.150.254.455.037.838.442.646.747.343.243.848.252.548.444.344.845.443.854.052.954.152.257.963.564.364.3
3047.147.751.956.739.039.643.948.148.744.745.349.854.254.846.046.651.055.456.044.855.454.054.854.854.566.262.067.062.0
3148.649.253.557.758.440.240.845.149.550.146.146.851.355.846.251.355.856.447.648.352.757.856.847.051.555.956.862.868.8
3250.050.655.059.359.941.341.946.851.447.548.252.748.252.757.357.957.448.958.459.959.647.958.558.058.069.561.571.272.1
3452.753.357.862.362.943.444.048.653.153.850.050.755.460.250.860.858.954.158.850.959.459.259.960.060.869.475.976.8
3553.954.659.163.664.344.345.049.654.354.951.251.956.761.562.253.454.158.963.764.452.052.657.562.363.063.771
表 4
孕龄(周)肱骨长(mm)肱骨长(mm)肱骨长(mm)肱骨长(mm)桡骨长(mm)桡骨长(mm)桡骨长(mm)桡骨长(mm)尺长(mm)尺长(mm)尺长(mm)尺长(mm)胫骨长(mm)胫骨长(mm)胫骨长(mm)胫骨长(mm)腓骨长(mm)腓骨长(mm)腓骨长(mm)腓骨长(mm)足长(mm)足长(mm)足长(mm)足长(mm)足长(mm)
孕龄(周)-3SD-2SD均数+2SD+3SD-3SD-2SD均数+2SD+3SD-3SD-2SD均数+2SD+3SD-3SD-3SD-2SD均数+2SD-3SD均数+2SD-3SD均数
121.63.57.110.812.60.32.05.59.010.81.93.77.310.912.72.54.27.611.112.81.73.46.810.211.94.15.7
135.17.010.714.416.32.84.68.211.813.64.16.09.613.315.23.95.69.212.714.43.25.08.512.013.76.78.3
148.410.314.117.919.85.57.311.014.716.66.78.612.416.018.06.07.811.415.016.85.47.210.814.416.29.211.0
1511.513.417.321.223.28.210.113.917.719.59.511.415.319.221.18.510.314.117.89.68.09.813.517.219.111.913.8
1614.516.520.424.426.410.812.816.720.522.512.314.318.222.224.211.213.116.920.722.710.712.616.420.222.114.516.5
1717.319.323.427.529.513.415.419.323.325.315.017.121.225.227.314.015.919.923.825.713.415.419.323.225.217.219.3
1820.022.126.230.432.415.817.821.926.028.017.819.824.028.230.316.818.822.826.828.816.218.226.328.319.922.126.631.133.3
1922.624.728.933.115.318.120.224.328.530.620.422.526.831.133.219.521.625.729.831.918.920.925.129.231.322.624.929.634.336.6
2025.027.231.535.838.020.322.426.730.933.022.935.422.925.129.433.836.022.224.328.532.734.821.523.627.932.124.225.327.732.637.540.0
2127.429.634.038.340.522.324.528.933.235.425.227.532.425.732.036.438.724.826.931.235.630.934.937.027.930.535.640.743.336.640.743.335.640.737.029.930.535.640.743.336.639.040.943.128.639.431.343.629.631.836.440.943.143.629.631.836.440.943.128.731.035.535.740.142.433.135.941.547.049.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.849.830.934.039.237.942.544.935.738.644.450.153.054.058.858.864.758.865.238.238.238.437.038.438.038.438.438.038.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.738.438.438.738.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.439.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.439.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.439.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.439.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.438.739.439.438.739.438.739.438.739.4<start>12<
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中华医学会超声医学分会. 胎儿生物学参数超声参考值专家共识——肱骨长、桡骨长、尺骨长、胫骨长、腓骨长、足长[S/OL]. .