初产妇经阴道分娩所致耻骨和耻尾肌损伤的MRI研究

目的 探讨经阴道分娩所致耻骨损伤与耻尾肌损伤的发生差异以及2种损伤严重程度的相关性。 方法 回顾性分析88例初产妇经阴道分娩后的盆腔MRI影像。根据MR影像上有无耻骨损伤,将产妇分为耻骨损伤组（51例）和无耻骨损伤组（37例）。由2名高年资放射科诊断医师在MRI影像上判断和评估耻骨及耻尾肌损伤情况,包括耻骨的骨髓水肿、骨折,以及耻尾肌水肿、撕裂和断裂,并对损伤程度进行评分。采用独立样本t检验、Mann-Whitney U检验、卡方检验及Fisher精确概率检验比较有无耻骨损伤的2组临床资料和影像表现,不同耻骨损伤程度间的耻尾肌损伤发生率比较采用Fisher精确概率检验。采用Kendall`s tau-b相关分析耻骨损伤程度与耻尾肌损伤程度的相关性。 结果 耻骨损伤组骨盆痛、压力性尿失禁及耻尾肌损伤发生率均高于无耻骨损伤组（均P<0.05）。耻骨损伤程度不同,其耻尾肌损伤发生率不同（P<0.05）,耻骨骨折,重度、中度及轻度骨髓水肿产妇的耻尾肌损伤发生率依次减低。耻骨损伤程度与耻尾肌损伤程度呈正性线性相关（r=0.297,P=0.036）。 结论 经阴道分娩的初产妇如有耻骨损伤则往往伴发耻尾肌损伤,并且耻骨损伤越严重,耻尾肌损伤发生率越高、程度越重。

MRI study of pubic bone and pubococcygeus muscle injury in transvaginal delivery primipara

Objective To explore the difference between the pubic bone injury and the pubococcygeus muscle injury caused by vaginal delivery and the correlation between the severity of the two injuries in primiparas. Methods A retrospective analysis was performed on the postpartum pelvic MR images of 88 cases of primiparous women who had undergone transvaginal delivery. The primiparas were separated into two groups, pubic bone injury group (51 cases) and non- pubic bone injury group (37 cases), based on the presence or absence of pubic bone injury on MRI images. On MRI images, two senior radiologists judged and evaluated the injury status of the pubis and pubococcygeus muscle, including pubic bone marrow edema, pubic fractures, and pubococcygeus muscle edema, tear and rupture, and scored their severity. Independent samples t test, Mann-Whitney U test, chi-square test and Fisher's exact probability test were used to compare the differences in clinical data and imaging findings between groups with and without pubic bone injury. Fisher’s exact probability test was used to compare the incidence of pubococcygeus muscle injury between different pubic injury degrees. Kendall’s tau-b correlation analysis was preformed to explore the correlation between the score of pubic injury and the score of pubococcygeus muscle injury. Result The incidence of pelvic pain, pressure urinary incontinence and pubococcygeus muscle injury in the pubic injury group were higher than those in the non-pubic injury group (P<0.05). The incidence of pubococcygeus muscle injury was different according to the degree of pubic injury (P<0.05). The incidence of pubococcygeus muscle injury in primiparous with pubic fracture, severe, moderate, and mild bone marrow edema decreased sequentially. There was a positive linear relationship between the degree of pubic bone injury and the degree of pubococcygeus muscle injury (r=0.297, P=0.036). Conclusion Primary vaginal delivery women are often accompanied by pubococcygeus muscle injury if they have pubic bone injury, and the more severe the pubic bone injury, the higher the rate and severity of pubococcygeus muscle injury.