数字化骨产道三维平台的建立及其在头位分娩中预测价值的研究

The pelvis is the most basic factor affecting delivery. Excessive diagnosis about cephalopelvic disproportion is one of the most important factors leading to cesarean section. The lack of a platform for objective pelvic measurement and cephalopelvic relationship evaluation is one of the important reasons that cause such incorrect diagnosis. Both X-ray and two-dimensional CT/MRI measurements are unable to complete the accurate measurement of the pelvis and virtually demonstrate the cephalopelvic relationship. Three-dimensional reconstruction technology brings pelvis research into the digital era, the evaluation of pelvic morphology and its significance for delivery prediction making first appearance recently. The technology of reconstructing three-dimensional pelvic based on CT data is mature now, but the application of X-ray is not suitable for pregnant women. MRI has no radiation and the soft tissue imaging is good, but it runs into a sea of troubles reconstructing pelvis, which explains why there is still no report about pelvic MRI three-dimensional reconstruction and measurement. After mastering the precision measurement technology of female pelvis CT three-dimensional reconstruction, we spent 3 years on exploration and have taken control of MRI three-dimensional reconstruction of the female pelvis and precision measurement technology. Based on the MRI data of pelvis and fetal head from full-term head position pregnant women, the present project aims to reconstruct a three dimensional bony birth canal that can show the living cephalopelvic relationship and establish cephalopelvic relationship evaluation platform. This project also investigates the predictive significance of digital bone canal for cephalic delivery, by means of the statistical analysis of delivery outcome and maternal and child data, so as to provide reference for reducing cesarean section rate.

骨盆是影响分娩的最基本因素，临床上头盆不称的过度诊断是剖宫产率居高不下的重要因素之一，缺乏客观的骨盆内径测量和头盆关系评估平台是导致该诊断不正确的重要原因。X线、二维CT/MRI均无法完成骨盆的精准测量和直观体现头盆关系，三维重建技术将骨盆研究带入三维时代，其对头盆关系的评估及对分娩的预测意义初现端倪。利用CT数据三维重建骨盆的技术已经成熟，但有射线损害，MRI无辐射、有软组织成像好等优点，但对骨盆的重建却困难重重，故目前无骨盆MRI三维重建及测量的报道。我们在掌握了女性骨盆CT三维重建精准测量技术后，通过3年的探索已初步掌握MRI数据三维重建女性骨盆和精准测量的技术。本课题拟利用足月头位胎儿孕妇盆腔和胎头的MRI数据，重建能展示活体头盆关系的三维骨产道，建立头盆关系的评估平台，并通过对其分娩结局和母婴资料的统计分析，研究数字化三维骨产道对头位分娩的预测价值，为降低剖宫产率提供参考。

骨盆是影响分娩的最基本因素，临床上头盆不称的过度诊断是剖宫产率居高不下的重要因素之一，缺乏客观的骨盆内径测量和头盆关系评估平台是导致该诊断不正确的重要原因。X 线、二维 CT/MRI 均无法完成骨盆的精准测量和直观体现头盆关系，三维重建技术将骨盆研究带入三维时代，其对头盆关系的评估及对分娩的预测意义初现端倪。利用 CT 数据三维重建骨盆的技术已经成熟，但有射线损害，MRI 无辐射、有软组织成像好等优点，但对骨盆的重建却困难重重。本研究纳入302例足月孕妇，通过探讨其MRI数据采集和三维重建方法，成功构建足月孕妇完整骨盆及胎儿的三维模型，通过三维测量以及构建虚拟分娩模型，分析其在临床的应用，过程顺利，无研究相关母胎损伤。得出结论认为：①FSE和2D-FIESTA分别为孕妇骨盆及胎儿适用于三维重建的最佳成像序列。②基于MRI数据集可构建出骨盆与胎儿相对空间关系模型，直观展示在体头盆关系。③利用三维模型，可以对骨盆及胎儿进行精准全面的测量。④MR三维体积预测胎儿出生体重是可行的，准确性较超声高，但呈低估趋势。⑤中骨盆前后径、出口前后径，尤其出口后矢状径较中骨盆横径对分娩结局影响更大，临床医生应重视骨盆前后径大小的评估。⑥可构建虚拟分娩模型来直观评估头盆关系。虚拟分娩模型展示为头盆不称时，难产可能性高。此外还分析妊娠分娩对骨盆及盆底的影响。⑦妊娠晚期妇女肛提肌结构发生重塑，趋向松弛改变，邻近阴道形态可发生变化，器官位置下移。⑧妊娠对初产妇骨盆的影响主要表现在关节上，耻骨弓角度变大，骨盆倾斜度减小。.通过以上结论，建立了头盆关系的评估平台，能个体化评估骨盆与胎儿的大小形状及头盆关系，可产前发现是否存在头盆不称的孕妇，从而指导选择合适的分娩方式，避免不必要的择期剖宫产及减少急诊剖宫产。