Anthropometric measurements in the diagnosis of pelvic size: an analysis of maternal height and shoe size and computed tomography pelvimetric data

Background To determine whether measurements of maternal height and shoe size are predictors of pelvic size, using erect lateral computerized tomography (CT) pelvimetry as gold standard. Materials and methods Three hundred and fifty three obstetric patients out of a sequential population of 6112 (5.8%) had CT pelvimetry performed between January 1990 and December 1991 at the Department of Obstetrics and Gynecology, York District Hospital, United Kingdom. Multivariable logistic regression models were built using maternal height (n = 322), shoe size (314) and weight at last clinic visit (n = 318). The reference standard for pelvic size was CT Pelvimetry. Pelvic adequacy was defined as an anterior-posterior diameter of the inlet of ≥11 cm and an anterior-posterior diameter of the outlet ≥10 cm on erect lateral CT pelvimetry. Women with values lower than these were regarded as having an inadequate pelvis. The diagnostic accuracy of the models was determined by the area under the receiver operating characteristic curve (AUC). Results The area under the curve (AUC) for maternal height (0.768) was not significantly greater than that for shoe size (0.686, p = 0.163 for the difference in AUC’s) and weight at the last clinic visit (0.655, p = 0.057 for the difference in the AUCs). The change in the AUC for each of the models (the full model with height, shoe size and weight [0.769]; model for height and shoe size [0.767] model for just height [0.768]) was also not significantly different. Conclusions Measurements of maternal height, shoe size and weight at the last clinic visit are not useful for the identification of women with inadequate pelvis.     

An evaluation of the EOS X-ray imaging system in pelvimetry

ObjectivesTo demonstrate the reliability of the EOS imaging system in measuring the internal diameters of the bony pelvis.Materials and methodsA prospective study comparing the results of the pelvimetry of 18 dry pelvises carried out on the EOS imaging system to measurements taken manually and using the two current gold standard CT methods. Pelvimetric measurements of each pelvic bone were obtained using four methods and compared: direct manual measurements, spiral and sequential CT pelvimetry, and 2D-3D low-dose biplanar X-rays. The various obstetric diameters were measured to the millimetre and compared.ResultsThere was no significant difference in the different diameters assessed, with the exception of the interspinous diameter. There was a highly significant correlation (P < 0.001) between the values measured manually and by EOS for the Magnin index (Pearson = 0.98), the obstetric conjugate diameter (Pearson = 0.99), and the median transverse diameter (Pearson = 0.87).ConclusionThe EOS imaging system allows for an ex vivo determination of the obstetrical diameters that is reliable enough to estimate obstetric prognosis, producing comparable measurements to CT. In view of concerns about protection from radiation, this low-dose imaging technique could become, after in vivo prospective validation, the new gold standard for pelvimetry and therefore a good alternative to CT.     

退行性腰椎滑脱与退行性腰椎椎管狭窄症患者脊柱-骨盆矢状面参数的差异

目的应用骨盆半径(PR)技术分析退行性腰椎滑脱(DLS)与退行性腰椎椎管狭窄症(DSS)患者脊柱-骨盆参数的特点,并探讨其代偿机制。方法回顾性分析2015年9月—2017年8月宁夏医科大学总医院收治的36例DLS和35例DSS患者的影像学资料。在站立位全脊柱侧位X线片上测量脊柱矢状面平衡(SVA)、总腰椎骨盆前凸角(PR-T_(12))、骨盆形态(PR-S_1)、骨盆角(PA)、腰椎前凸(LL)和胸椎后凸(TK)。将2组所测参数分别与健康国人脊柱-骨盆参数进行比较,同时采用Pearson相关分析研究各脊柱骨盆-参数之间的相关性。结果 DLS组与DSS组中SVA、PA均明显大于正常参考值,差异有统计学意义(P0.05)。DSS组PR-T_(12)明显小于正常参考值,DLS组PR-S_1明显小于正常参考值,差异均有统计学意义(P0.05)。DLS组PR-T_(12)与PA的相关性强于与LL、TK的相关性,DSS组PR-T_(12)与LL、TK的相关性强于与PA的相关性。DLS组PR-S_1与PA呈负相关,DSS组PR-S_1与PA无相关性。结论 DLS患者可能主要通过骨盆后倾维持脊柱矢状位平衡,DSS患者可能主要通过改变胸腰椎曲度维持脊柱矢状位平衡。     

Pelvic minus fetal diameter: value of pelvimetry in the detection of cephalopelvic disproportion

Cephalopelvic disproportion between pelvic and fetal diameters has been evaluated by pelvimetry. The study consisted of 257 women with pelvimetry by digital-image-intensifier radiography and fetometry by US. Information about the management of labour and the mode of delivery has been obtained from the obsterician. Differences between five pelvimetric diameters and the fetal biparietal diameter (BIP) have been correlated to the mode of delivery. Kruskal-Wallis and Mann-Whitney U-tests show high significance for small or negative differences between interspinous as well as intertuberous distance and BIP in the group of Caesarean sections. According to empirical determination cephalopelvic disproportion can be supposed for differences 0.0 cm and borderline conditions for 0.0–1.0 cm. The investigated sagittal pelvic diameters did not show a correlation to the mode of delivery. For the detection of cephalopelvic disproportion interspinous distance-BIP is suited best. In conclusion, the plane of the mid-pelvis has been found to be the most important parameter. Correspondence to: K. J. Lehmann     

中国人髋关节中心边缘角正常值的测量

目的 通过测量1 494例正常骨盆正位片的中心边缘角(center-edge angle,CEA),得出国人髋关节CEA的正常值范围,指导临床阅读骨盆正位片.方法 测量4岁以后健康人群骨盆正位片的CEA,4～18岁按年分组,>18岁每10年分为一组.同时采用Ⅲ型髓臼2种CEA测量方法 (经典CEA和改良CEA),统计分析测得的各个年龄组的正常参考值和数值-年龄变化曲线.结果CEA 4岁时为21.62°,9岁时增大至25.07°,18岁时增大为32.14°,18岁之后,CEA基本在30°～34°波动.Ⅲ型髋臼主要见于4～9年龄组,这时二种CEA测量相差10°～12°左右.结论 10～14岁是CEA快速增大期,Ⅲ型髋臼主要见于4～9岁年龄组,此时经典CEA>25°且改良CEA>15°可认为是正常的.     

Magnetic resonance assessment of pelvic anatomy and pelvic floor disorders after childbirth

To compare pelvic anatomy, using magnetic resonance imaging, between postpartum women with or without pelvic floor disorders. We measured postpartum bony and soft tissue pelvic dimensions in 246 primiparas, 6–12-months postpartum. Anatomy was compared between women with and without urinary or fecal incontinence, or pelvic organ prolapse; P < 0.01 was considered statistically significant. A deeper sacral hollow was significantly associated with fecal incontinence (P = 0.005). Urinary incontinence was marginally associated with a wider intertuberous diameter (P = 0.017) and pelvic arch (P = 0.017). There were no significant differences in pelvimetry measures between women with and without prolapse (e.g., vaginal or cervical descent to or beyond the hymen). We did not detect meaningful differences in soft tissue dimensions for women with and without these pelvic floor disorders. Dimensions of the bony pelvis do not differ substantially between primiparous women with and without postpartum urinary incontinence, fecal incontinence and prolapse.     

髋关节疾病脊柱骨盆矢状面平衡研究现状和发展

脊柱、骨盆和下肢构成的骨骼支架,共同维持着躯体在矢状面的整体平衡。髋关节疾病患者在矢状面上会出现不同程度的异常表现,众多参数已被应用到评价患者生存质量和术后临床效果上。随着脊柱骨盆矢状面平衡的研究深入,髋关节疾病的矢状面平衡逐渐被更多的学者重视。因此本文对脊柱－骨盆矢状面形态的影像学评价、临床意义和在髋关节疾病患者中的研究现状作一综述,为后续的研究提供参考。     

Dynamic assessment of pelvic floor and bony pelvis morphologic condition with the use of magnetic resonance imaging in a multiethnic, nulliparous, and healthy female population

OBJECTIVE: The purpose of this study was to determine dynamic pelvic floor and bony pelvis morphologic condition in asymptomatic multiethnic women. STUDY DESIGN: Pelvic floor anthropometry, at rest and after the Valsalva maneuver, and pelvimetry were compared with the use of magnetic resonance imaging in nulliparous young volunteers from 5 ethnic groups (n=11 x 5 volunteers: Emirati, other Arab, Filipino, Indian/Pakistani, and European/white volunteers), with the white volunteers as the reference group. RESULTS: The white volunteers were significantly taller (P <.0001) than the other women. Their levator hiatus was significantly longer than the Emirati women (P=.03) and wider than the Filipino women (P=.04). The bladder neck descent on straining was also significantly greater than the other groups (P <.00001). The white women also had the longest transverse diameter of the pelvic inlet (P=.002). Their sagittal outlet diameter was significantly longer than the Emirati and Arab women (P=.02), and their interspinous diameter was significantly longer than the Arab women (P=.002). CONCLUSION: Nulliparous, healthy white women have larger levator hiatus and bony pelvis with greater bladder neck descent on straining than non-white women.     

基于铅垂线观察脊柱矢状面平衡的可行性

目的探讨借助C_7铅垂线(C_7PL)来观察站立位脊柱矢状面稳定性的可行性。方法选取59名健康青少年的站立侧位脊柱全长X线片,由2位医师在医学影像存档与传输系统(PACS)工作站上通过Cobb法和C_7PL法独立测量脊柱矢状面参数,前者包括胸椎后凸角(TK)、腰椎前凸角(LL),后者包括T_6椎体与C_7PL距离(T_6PL)、L_4椎体与C_7PL距离(L_4PL)、骶骨上终板后上角与C_7PL距离(矢状面轴向距离,SVA)、股骨头中心与C_7PL距离(FPL),比较2种测量方法的重复性和相关性。结果以Cobb法测量,A医师测量的TK和 LL分别为24.1°±11.5°、51.0°±8.5°,B医师测量的TK和LL分别为28.1°±8.1°、49.4°±6.0°,2位医师测量的TK差异有统计学意义(P 0.05)并呈中度相关(r=0.662),测量的LL差异无统计学意义(P 0.05)且呈高度相关(r=0.873)。以C_7PL法测量,A医师测量的T_6PL和L_4PL分别为(27.3±19.0)mm、-(43.5±19.7)mm,B医师测量的T_6PL和L_4PL分别为(24.3±13.2)mm、-(45.5±25.9)mm,两位医师测量的T_6PL和L_4PL差异均无统计学意义(P 0.05)且呈极高度相关(r=0.905,r=0.936)。对Cobb法和C_7PL法的测量结果进行相关分析,结果显示,TK与T_6PL呈高度相关(r=0.760),LL与L_4PL呈中度负相关(r=-0.592)。对C_7PL法的测量指标进行相关分析,结果显示,T_6PL与L_4PL呈中度负相关(r=-0.655),与SVA呈低度负相关(r=-0.404),与FPL呈中度负相关(r=-0.646)。结论基于C_7PL观察脊柱矢状面曲度变化是可行的,且重复性可能更好,是整体观察脊柱-骨盆-下肢矢状面各部位相互平衡性的有效方法,值得试用。     

青少年L5/S1峡部裂性腰椎滑脱患者脊柱-骨盆矢状面形态分析

目的探讨青少年L_5/S_1峡部裂性腰椎滑脱患者的脊柱-骨盆矢状面形态改变。方法回顾性分析2009年10月—2017年1月收治的29例青少年L_5/S_1峡部裂性腰椎滑脱患者影像学资料,以30例年龄匹配的正常青少年影像学资料作为对照。在站立位全脊柱侧位X线片上测量滑脱角(SA)、滑脱距离(SD)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、骨盆矢状面厚度(SPT)、L_5入射角(L_5I)、腰椎前凸角(LL)、胸椎后凸角(TK)、脊柱矢状位平衡(SVA)、骶骨平台角(STA)、S_1指数、腰骶角(LSA)等脊柱-骨盆矢状面参数,并计算滑脱率(SP),比较滑脱组与对照组以及低滑脱(SP≤17%)与高滑脱(SP17%)亚组之间的差异,并采用Pearson相关检验分析SP与各影像学参数的相关性。结果滑脱组SA为-4.5°±9.6°,SD为(7.1±3.6)mm,SP为(22.2±11.1)%。滑脱组的LSA、STA、S_1指数小于对照组,PI、PT、SS、SPT、L_5I、SVA及LL大于对照组,差异均有统计学意义(P0.05);2组TK差异无统计学意义(P0.05)。高滑脱亚组的SA、TK、LSA、STA及S_1指数均显著小于低滑脱亚组,PI、PT、SS、SPT、L_5I和SVA均大于低滑脱亚组,差异均有统计学意义(P0.05);2个亚组的LL差异无统计学意义(P0.05)。滑脱组PI、PT、SPT、L_5I、LL与SP呈正相关,TK、LSA、STA及S_1指数与SP成负相关,SS、SVA与SP无明显相关性。结论腰骶部先天发育不良可能是青少年峡部裂性腰椎滑脱发生的始动因素。受滑脱程度影响,其脊柱-骨盆矢状面形态显著异常,表现出腰椎前凸增大、躯干前倾,同时骨盆后旋、屈髋屈膝等异常代偿姿势。